Use of network analysis multidrug-resistant tuberculosis contact investigation in Kanchanaburi, Thailand.

OBJECTIVE: To characterise MDR-TB outbreak and incorporate social network analysis with contact investigation to detect case-contact linkages and clusters. METHODS: MDR-TB cases registered in the district hospital between October 2012 and September 2015 were interviewed and their contacts were investigated. A relationship-based weighted network was constructed. RESULTS: Among 43 interviewed MDR-TB cases, 20 (47%) were male, five (12%) were asymptomatic (and discovered incidentally) and 22 (51%) had underlying diseases. From the documented 115 contacts, 61 (53%) were household contacts and 49 (43%) were close (non-household) contacts; 70 (61%) were screened for TB using various tests. In this network, we prioritised 37 contacts connected with more than one MDR-TB patient. The largest cluster was identified in the pharmacy unit of the hospital. CONCLUSION: This investigation yielded a significant number of MDR-TB contacts, and social network analysis facilitated the prioritisation for screening. Social network analysis is useful and feasible in this program setting and complements MDR-TB contact investigation.

OBJECTIF: Caractériser une épidémie de TB-MDR et incorporer une analyse du réseau social avec une investigation sur les contacts pour détecter les liens et les regroupements cas-contacts. MÉTHODES: Les cas de TB-MR enregistrés à l'hôpital de district entre octobre 2012 et septembre 2015 ont été interrogés et leurs contacts ont été investigués. Un réseau pondéré sur base de la relation a été construit. RÉSULTATS: Sur 43 cas de TB-MDR interviewés, 20 (47%) étaient des hommes, cinq (12%) étaient asymptomatiques (et ont été découverts fortuitement) et 22 (51%) avaient des maladies sous-jacentes. Parmi les 115 contacts recensés, 61 (53%) étaient des contacts dans le ménage et 49 (43%) étaient des contacts proches (hors ménage); 70 (61%) ont été dépistés pour la TB à l'aide de divers tests. Dans ce réseau, nous avons priorisé 37 contacts reliés à plus d'un patient atteint de TB-MR. Le regroupement le plus important a été identifié dans l'unité de pharmacie de l'hôpital. CONCLUSION: Cette investigation a abouti à un nombre important de contacts avec la TB-MDR et l'analyse du réseau social a facilité l'établissement des priorités pour le dépistage. L'analyse du réseau social est utile et réalisable dans le cadre de ce programme et complète l'investigation sur les contacts de TB-MDR.

Injuries and deaths at a pub fire in Bangkok, Thailand on New Year's Eve 2009.

This investigation describes the 67 people who died and the 153 who were hospitalized from a New Years' Eve fire in a Bangkok pub. We interviewed survivors and reviewed medical charts and forensic reports of decedents. Survivors were young (median age 27 years), single (84.7%) and lived in Thailand (93.6%). Most were on the concert floor when the fire started (74.0%), became aware of danger when they saw flames (61.5%) and escaped through the main entry door (42.9%). Common injuries were burns (75.6%), smoke inhalation (47.4%) and open wounds (32.1%). The decedents' median age was 27 years and 88.1% lived in Thailand. Most of the dead bodies were found at or near the main entrance. The main causes of death were asphyxia (88.1%) or burn (10.4%). Soot was present in the trachea of 95.5% of the decedents. Carboxyhemoglobin level in 37.5% was in the toxic range. The average percent of body surface burned was 75.0%. Loss of consciousness in the pub (RR 3.5, 95% CI 1.7-7.3) was a risk factor for severe injury and smoke inhalation (RR 9.3, 95% CI 3.1-28.0) was a risk factor for death.

Regional variations in HIV disclosure in Thailand: implications for future interventions.

People living with HIV (PLH) in Thailand face tremendous challenges, including HIV disclosure. With the advent of antiretroviral (ARV) therapy in Thailand, the positive benefits of HIV disclosure are becoming more salient. However, there are regional variations in the levels of HIV disclosure in Thailand. We examined and compared the levels of HIV disclosure in Northern and Northeastern Thailand. PLH (N = 410) were recruited from four district hospitals in the North and the Northeast. More PLH in the North reported disclosing HIV status to at least one family member in the household. PLH in the Northeast reported significantly lower levels of HIV disclosure within family and outside of family. HIV disclosure remains a significant challenge in Thailand, especially in the Northeast. We propose future interventions focusing on HIV disclosure to address the specific concerns and barriers to HIV disclosure, taking into account the regional differences in HIV disclosure.

An outbreak of hospital-acquired Staphylococcus aureus skin infection among newborns, Nan Province, Thailand, January 2008.

In January 2008, we investigated a cluster of neonates with bullous impetigo in a hospital of northern Thailand in order to control the outbreak and identify a potential source of the infection. We reviewed medical records and working timetables of healthcare workers (HCWs) and conducted a case-control study. We performed an environmental study and took bacteriological samples from HCWs and equipments. According to our case definitions, we identified 16 confirmed cases and 14 probable cases. The attack rate was 42%. Most cases had skin blisters (28 cases) followed by pustules (five cases) and exfoliation (three cases). The location of the lesion was the trunk (17 cases), neck (14 cases) or armpits (nine cases). Nineteen cases had symptoms onset after discharge from hospital. Median age at onset was 4 days. The strain isolated from an infected newborn shared the same phage type as the contaminated equipment. Insufficient hand hygiene was an observed risk behaviour of HCWs and visitors. Exposure to a nasal carrier of Staphylococcus aureus (adjusted OR: 80.3, 95% CI: 4.8 - 1350.3) and ward sharing with a symptomatic case (adjusted OR: 35.6, 95% CI: 1.9 - 654.7) increased the risk of acquiring the infection. The outbreak ended abruptly after implementation of hand hygiene practices and equipment cleaning.

Long-term capacity-building in public health emergency preparedness in Thailand--short report.

Thailand's long-term commitment to public health workforce capacity-building and its health infrastructure were key components in its successful response to the December 26, 2004 tsunami disaster. Surveillance and Rapid Response Teams, comprising fellows and staff from the Field Epidemiology Training Programme of Thailand, in collaboration with staff from the Thailand Ministry of Public Health---U.S Centers for Disease Control and Prevention and the World Health Organization, enabled a rapid and an effective public health response. Active surveillance, outbreak response and control, rapid health assessments, and mental health surveys provided critical information on the public health priorities and medical needs of the impacted populations. Environmental assessments of temporary morgues led to health safety and infection-control recommendations, and computerised surveillance systems assisted in victim tracking and identification. Thailand's experience demonstrates the importance of a prepared public health sector in mitigating the impact of disasters, and supports the recommendation of the Fifty-Eighth World Health Assembly for Member States to develop preparedness plans that include building capacity to respond to health-related crises.

Investigation of avian influenza (H5N1) outbreak in humans--Thailand, 2004.

INTRODUCTION: Beginning in late 2003, a substantial outbreak of influenza A (H5N1) virus spread among poultry in Thailand. On January 23, 2004, the Ministry of Public Health (MPH) detected the first confirmed human case of H5N1 infection in humans. METHODS: During February-November 2004, the MPH's Bureau of Epidemiology and provincial health offices worked together to investigate the H5N1 outbreak in humans. Two studies were conducted: a descriptive study to describe clinical manifestations and epidemiologic characteristic of the cases and a matched case-control study to determine risk factors for persons who might subsequently become ill with H5N1. RESULTS: A total of 16 patients with confirmed H5N1 were identified for the case-control study. Fever and respiratory symptoms predominated. Leucopenia and thrombocytopenia were present respectively in nine (100%) and four (44%) persons aged <15 years. Direct touching of unexpectedly dead poultry was the most significant risk factor (odds ratio = 29.0; 95% confidence interval = 2.7-308.2). Overall mortality was 75%; mortality for persons aged <15 years was 90%, compared with 57% for persons aged > or =15 years. CONCLUSION: Avian influenza was more severe in children, who should avoid handling dead poultry during epizootics. Early avian influenza in children resembled the more common dengue fever, but presence of cough and absence of hemoconcentration distinguished avian influenza, which often progressed rapidly to acute respiratory distress syndrome, requiring intensive care.

Infection with hepatitis C virus among intravenous-drug users: prevalence, genotypes and risk-factor-associated behaviour patterns in Thailand.

Hepatitis C virus (HCV) infection, a major problem worldwide, is usually transmitted parenterally or by use of contaminated needles among intravenous-drug users (IVDU). In a cross-sectional study, demographic data were collected and behaviour patterns investigated in interviews with 453, consenting IVDU. Blood samples were collected from each interviewee and checked for anti-HCV antibodies and, in a PCR-based assay, for the RNA of HCV. Almost all (92.5%) of the IVDU investigated were found positive for anti-HCV and/or the viral RNA. Most (73.5%) of those positive for HCV RNA were found to be infected with genotype 3a alone, the rest being infected with 1b (17.9%), 6a (3.5%), 3b (1.4%), 1a (1.0%), or both 3a and 6a (2.1%) or having non-typable infections (0.6%). Curiously, 26.0% of those who appeared seronegative for anti-HCV were positive for HCV RNA. The longer an interviewee had been using intravenous drugs, the more likely he or she was to be infected with HCV. Among the IVDU, the sharing of needles, syringes and/or other drug-related paraphernalia appeared to be the behaviour carrying the highest risk of HCV infection, giving an adjusted odds ratio and (95% confidence interval) of 4.84 (1.88-12.43). Programmes of needle and syringe exchange should probably be implemented among IVDU in Thailand and elsewhere, to slow the transmission of HCV.

A second outbreak of cholera in the home for mentally handicapped, Nonthaburi.

A second outbreak of cholera, due to the Ogawa strain, occurred in the home for Mentally Handicapped Children in Nonthaburi between July 29 and August 9, 1992. An outbreak of cholera due to the Inaba strain was reported in the same institution and season tin 1987. In 1992, the clinical attack rate was 8 per cent of 440 children; there were two deaths. Bath water was contaminated with Vibrio cholerae O1 E1 Tor Ogawa, the same strain as was isolated from the ill children. Chlorination of the water supply, obtained from an underground well, was insufficient. The water supply needs further investigation, and the sanitary conditions in the institutions should be improved.