Thailand's national strategic plan on antimicrobial resistance: progress and challenges.

Antimicrobial resistance is a serious threat that affects all countries. The Global Action Plan on antimicrobial resistance and the United Nations Political Declaration on antimicrobial resistance set standards for countries to resolve antimicrobial resistance challenges under the One Health approach. We assess progress and challenges in implementing Thailand's national strategic plan on antimicrobial resistance 2017-2022, discuss interim outcomes and share lessons learnt. Major progress includes: establishing a national governance mechanism that leads high-impact policy on antimicrobial resistance and consolidates actions and multisectoral collaboration; creating a monitoring system and platform to track implementation of the strategic plan; and converting strategies of the strategic plan into actions such as controlling the distribution and use of antimicrobials in humans and animals. Interim results indicate that antimicrobial consumption in animals has nearly halved (exceeding the national goal of a 30% reduction) whereas other goals have not yet reached their targets. We have learnt that elevating antimicrobial resistance to high-level visibility and establishing a national governance mechanism is an important first step, and a monitoring and evaluation system should be developed in parallel with implementation. Securing funds is crucial. Policy coherence is needed to avoid duplication of actions. Highly ambitious goals, although yet to be achieved, can advance actions beyond expectations. Political commitment and collaboration across different sectors will continue to play important roles but might not be sustained without a well-designed governance structure to support long-term actions to address antimicrobial resistance.

La résistance aux antimicrobiens fait peser une sérieuse menace sur la planète tout entière. Le Plan d'action mondial pour combattre la résistance aux antimicrobiens ainsi que la Déclaration politique des Nations Unies sur la résistance aux agents antimicrobiens ont défini des normes pour les pays, afin qu'ils puissent faire face aux enjeux liés à la résistance aux antimicrobiens selon l'approche «One Health¼. Nous avons évalué les progrès et défis de la mise en œuvre du plan stratégique national de la Thaïlande en la matière pour 2017­2022, mais aussi discuté des résultats provisoires et partagé les enseignements tirés. Parmi les principaux progrès accomplis figurent l'établissement d'un mécanisme de gouvernance national pour mener une politique à impact élevé sur la résistance aux antimicrobiens, renforcer les actions et favoriser la collaboration intersectorielle; la création d'un système de surveillance et d'une plateforme pour suivre la mise en œuvre du plan stratégique; et enfin, la conversion des stratégies du plan en actions telles que le contrôle de la distribution et de l'usage des antimicrobiens chez les humains et les animaux. Les résultats provisoires indiquent que la consommation d'antimicrobiens chez les animaux a diminué de moitié (ce qui est supérieur à l'objectif national d'une réduction de 30%), tandis que les autres objectifs n'ont pas encore été atteints. Nous avons constaté qu'accroître la visibilité de la résistance aux antimicrobiens et instaurer un mécanisme de gouvernance national constituaient des étapes cruciales, et qu'un système de surveillance et d'évaluation devait être développé parallèlement à la mise en œuvre. L'obtention de financements est elle aussi essentielle. Une politique cohérente est nécessaire pour éviter de multiplier les actions similaires. Fixer des objectifs très ambitieux, même s'ils ne sont pas encore atteints, permet en outre de faire progresser les actions au-delà des attentes. Enfin, l'engagement politique et la collaboration entre différents secteurs continueront à jouer un rôle prépondérant, mais ne pourront peut-être pas se poursuivre sans une structure de gouvernance bien conçue, capable de soutenir des actions à long terme visant à remédier à la résistance aux antimicrobiens.

La resistencia a los antimicrobianos es una grave amenaza que afecta a todos los países. El Plan de Acción Mundial sobre la resistencia a los antimicrobianos y la Declaración Política de las Naciones Unidas sobre la resistencia a los antimicrobianos establecen normas para que los países resuelvan los problemas de resistencia a los antimicrobianos en el marco del enfoque «Una única salud¼. Evaluamos los avances y los desafíos en la aplicación del plan estratégico nacional de Tailandia sobre la resistencia a los antimicrobianos 2017-2022, analizamos los resultados provisionales y compartimos las lecciones aprendidas. Entre los principales avances se encuentran: el establecimiento de un mecanismo de gobernanza nacional que lidera la política de alto impacto sobre la resistencia a los antimicrobianos y consolida las acciones y la colaboración multisectorial; la creación de un sistema de seguimiento y una plataforma para seguir la aplicación del plan estratégico; y la conversión de las estrategias del plan estratégico en acciones como el control de la distribución y el uso de antimicrobianos en humanos y animales. Los resultados provisionales indican que el consumo de antimicrobianos en animales se ha reducido casi a la mitad (superando el objetivo nacional de una reducción del 30 %), mientras que otros objetivos aún no han alcanzado sus metas. Hemos aprendido que elevar la resistencia a los antimicrobianos a una visibilidad de alto nivel y establecer un mecanismo de gobernanza nacional es un primer paso importante, y que debe desarrollarse un sistema de seguimiento y evaluación en paralelo a la implementación. Asegurar los fondos es crucial. La coherencia política es necesaria para evitar la duplicación de acciones. Unos objetivos muy ambiciosos, aunque todavía no se hayan alcanzado, pueden hacer avanzar las acciones más allá de las expectativas. El compromiso político y la colaboración entre los distintos sectores seguirán desempeñando un papel importante, pero podrían no mantenerse sin una estructura de gobernanza bien diseñada que apoye las acciones a largo plazo para hacer frente a la resistencia a los antimicrobianos.

Self-assessment of the Thai Department of Disease Control's communication for international response to COVID-19 in the early phase.

OBJECTIVES: This study aimed to assess the Thailand Department of Disease Control's (DDC) early responses to COVID-19 in respect to communication with the international community and to identify the manner of Thailand's response during public health emergencies. METHODS: Documents and international response communication from 4-31 January 2020 were reviewed and dates of responses were collected for descriptive analysis. A questionnaire was submitted to the DDC officers responsible for international coordination. A meeting to identify responses was held to evaluate the self-assessed capacities of the Department's international communication. RESULTS: Thailand began the COVID-19 screening protocol on 3 January 2020. International correspondence subsequently occurred continually either through the ASEAN or International Health Regulations (IHR) mechanisms. The total score of communication for international response was 88.9%. For IHR reporting duties, the median duration to respond was 2.49hours. Official news was sent within a mean of 9.18hours and the English daily situation reports were always uploaded onto the official website within 24hours. CONCLUSIONS: This study provided a benchmark for international coordination and communication capacities and also identified areas for improvement during public health emergencies, such as the need to identify English-speaking spokespeople to communicate at an international level.

Seroprevalence of Coxiella burnetii Antibodies Among Ruminants and Occupationally Exposed People in Thailand, 2012-2013.

AbstractLittle is known about the burden of Q fever in Thailand. We conducted a serological study to describe the prevalence of anti-Coxiella burnetii antibodies among ruminants and occupationally exposed persons in response to the report of the first two Q fever endocarditis patients in Thailand in 2012. We randomly selected ruminant sera from brucellosis surveillance and examined sera of 661 occupationally exposed subjects from two provinces of Thailand: Chiangmai and Nakornratchasima. Animal and human sera were tested using commercial enzyme-linked immunosorbent assay (ELISA). Environmental samples, vaginal swab, and milk from cows in Chiangmai farms with detectable anti-C. burnetii serum antibodies were tested using polymerase chain reaction (PCR). Among the 1,632 animal sera tested, 64 (3.9%) were seropositive. The prevalence was highest in dairy cattle (4.6%, 45/988), followed by goats (3.5%, 18/516) and sheep (2.1%, 1/48). The prevalence of anti-C. burnetii antibodies in each species varied significantly by province: the prevalence in cattle was higher in Chiangmai (5.5% versus 0%), however, the prevalence in sheep and goats was higher in Nakornratchasima (5.9% versus 1.0%). Four out of 60 milk samples were positive by PCR (6.7%). No environmental samples were positive. Among 661 human samples, 83 (12.6%) were ELISA positive. Seroprevalence was statistically higher in Chiangmai compare with Nakornratchasima (42.8% versus 3.0%). Coxiella burnetii infection exists in Thailand, but the prevalence varies by geographic distribution and animal reservoirs. Further studies focusing on the burden and risk factors of C. burnetii infection among high-risk groups should be conducted.

Epidemiology of radiographically-confirmed and bacteremic pneumonia in rural Thailand.

Pneumonia remains a leading public health concern in Thailand. Using population-based surveillance during January 2004-December 2006, we describe incidence, mortality, and bacterial etiologies of chest radiograph-confirmed pneumonia requiring hospitalization in one rural Thai province. Of 19,316 patients who met the case definition for clinical pneumonia, 9,596 (50%) had a chest radiograph, and 4,993 (52%) of those had radiographically-confirmed pneumonia. The incidence of radiographically-confirmed pneumonia ranged from 199 to 256 per 100,000 persons per year; 151 (3.0%) patients died. The annual average pneumonia mortality rate was 6.9 per 100,000 persons (range 6.2 to 7.8 per 100,000) and was highest in persons aged < 1 year (64/100,000) and > or = 65 years (44/100,000). Of 4,993 patients with radiographically-confirmed pneumonia, 1,916 (38%) had blood cultures, and 187 (10%) of those had pathogens isolated. Pathogens causing bacteremic pneumonia included B. pseudomallei (15% to 24% of bacterial pathogens), E. coli (9.2% to 25%), S. pneumoniae (7.9% to 17%), K. pneumoniae (2.2% to 6.4%), and S. aureus (4.3 to 5.3%). Bacteremia was significantly associated with pneumonia mortality after controlling for age, sex, HIV status and measures of disease severity in a logistic regression model (OR=5.2; 95% confidence interval= 2.2-12). Pneumonia remains an important cause of morbidity and mortality in Thailand, as in other countries in Southeast Asia. These findings can inform pneumonia clinical management and treatment decisions and guide public health programming, including the development of effective prevention strategies.

Low frequency of infection with avian influenza virus (H5N1) among poultry farmers, Thailand, 2004.

In Thai provinces where avian influenza outbreaks in poultry had been confirmed in the preceding 6 months, serum from 322 poultry farmers was tested for antibodies to avian influenza virus subtype H5N1 by microneutralization assay. No study participant met the World Health Organization serologic criteria for confirmed infection.