Association of undernutrition with dengue, malaria and acute diarrhea among children in a Thai-Myanmar border.

BACKGROUND: Undernutrition has been shown to be associated with various infectious diseases. However, the recent improvement in nutritional status and management for infectious diseases worldwide necessitates the re-evaluation of this association. METHODS: A retrospective study was conducted in children aged <14 years old with dengue, malaria or acute diarrhea who visited or were admitted to Tha Song Yang hospital, near the Thai-Myanmar border. RESULTS: Most of the patients had mild disease and most of the undernourishment was mild. The prevalence of underweight in dengue, malaria and acute diarrhea was 24.0%, 34.7% and 38.7%, respectively, and the prevalence of low height for age was 12.0%, 36.0% and 36.0%, respectively. Malaria and acute diarrhea were associated with underweight but not low height for age. Dengue was neither associated with underweight nor low height for age. CONCLUSION: Although there has been an improvement in nutritional status and health care facilities, underweight has been still prevalent in rural areas and associated with malaria and acute diarrhea. IMPLICATION: The surveillance for nutritional status should be continuously performed particularly in children with some diseases, e.g. malaria and acute diarrhea, and additional food supplementation should be provided.

Seasonal prevalence, risk factors, and One Health intervention for prevention of intestinal parasitic infection in underprivileged communities on the Thai-Myanmar border.

BACKGROUND: Tha Song Yang District, located on the Thai-Myanmar border, contributes to the second highest cases of amoebic dysentery due to intestinal parasitic infections (IPI). However, there were limited disease prevalence data, specific surveillance systems, and interventions available. OBJECTIVE: This study aimed to explore the epidemiological features of the IPIs and apply the One Health (OH) approach to solve IPI-related problems. METHODS: Prevalence of asymptomatic infections in human and animals, yearly symptomatic cases, and associated risk factors were investigated. The OH intervention included improving the knowledge, attitude, and practice (KAP) of the community, microscopic diagnosis training, and stakeholder engagement for IPI prevention designs. RESULTS: The prevalence of asymptomatic cases was much higher than that of the symptomatic cases. Infective stages of the intestinal parasites were discovered in animal stool and water samples, indicating possible transmission routes. One year after the intervention, there were significant declines in asymptomatic IPIs and symptomatic cases of amoebic dysentery. Significant improvements in KAP and awareness regarding water and manure-waste management of the community were observed. CONCLUSION: We reported the successful application of the OH intervention in reducing the IPI prevalence and mitigating disease-related risks. The intervention might be applied to address other infectious diseases in the future.

Dengue viremia kinetics in asymptomatic and symptomatic infection.

BACKGROUND: Dengue infection is a global health threat. While symptomatic cases contribute to morbidity and mortality, the majority of infected people are asymptomatic but serve as an important reservoir. However, the kinetics of viremia in asymptomatic infections remains unknown. METHODS: We enrolled 279 hospital-based symptomatic index cases and quantified dengue virus (DENV) RNA at enrollment and at the day of defervescence. To identify asymptomatic cases, 175 household members of index cases were monitored for clinical symptoms during follow-up, and blood was taken twice weekly to test for and quantify DENV RNA until cleared. RESULTS: We detected DENV in thirteen asymptomatic household members (7.43%). Their DENV serotypes were primarily the same as those of their family index cases. The median peak DENV viremia in asymptomatic subjects was lower than that of symptomatic individuals during the febrile phase, and the viral decay rate was slower in asymptomatic infections. CONCLUSIONS: DENV level and kinetics in asymptomatic individuals differed significantly from those of symptomatic cases. Despite the lower viremia, the slower decay rate in asymptomatic infections could lead to their prolonging the infectious reservoir. The improvement of transmission control to prevent such long-lived asymptomatic infections from transmitting the DENV is needed.

Neutrophil Activation and Early Features of NET Formation Are Associated With Dengue Virus Infection in Human.

The involvement of the immune system in the protection and pathology of natural dengue virus (DENV) has been extensively studied. However, despite studies that have referred to activation of neutrophils in DENV infections, the exact roles of neutrophils remain elusive. Here, we explored the phenotypic and functional responses of neutrophils in a cohort of adult dengue patients. Results indicated that during an acute DENV infection, neutrophils up-regulate CD66b expression, and produce a more robust respiratory response as compared with that in convalescent or healthy individuals; this confirmed in vivo neutrophil activation during DENV infection. Spontaneous decondensation of nuclei, an early event of neutrophil extracellular trap (NET) formation, was also markedly increased in cells isolated from DENV-infected patients during the acute phase of the infection. In vitro incubation of NETs with DENV-2 virus significantly decreased DENV infectivity. Interestingly, increased levels of NET components were found in the serum of patients with more severe disease form-dengue hemorrhagic fever (DHF), but not uncomplicated dengue fever, during the acute phase of the infection. Levels of pro-inflammatory cytokines IL-8 and TNFα were also increased in DHF patients as compared with those in healthy and DF subjects. This suggested that NETs may play dual roles during DENV infection. The increased ability for NET formation during acute DENV infection appeared to be independent of PAD4-mediated histone H3 hyper-citrullination. Our study suggests that neutrophils are involved in immunological responses to DENV infection.

Accessibility of health care service in Thasongyang, Tak Province, Thailand.

Accessibility to health care services in Thailand is generally good, but a few areas in the country are difficult to reach. The purpose of this study was to investigate the accessibility of health care services in rural and remote areas of Thailand. It was conducted in 16 remote villages within a catchment area with a primary health care post. The health care post staff interviewed 394 respondents (197 males and 197 females) using a structured questionnaire. Most respondents utilized primary health care posts (98.5%) and medical institutes. Most of the respondents were Karen, had low incomes, and were illiterate. However, they had health insurance. Most of them took more than 30 minutes to travel from home to their primary health care post (60.9%), and took more time in the rainy season than in the dry season. Moreover, it took more than 2 hours for them to travel to the nearest hospital from their residences (64.5% in the dry season and 84.5% in the rainy season). They also paid more for medical services, travelling and food on the way to the hospital. Not only primary health care posts, but also many other medical institutes provided health care services in the villages. In conclusion, based on the results of this study, primary health care posts in remote areas are necessary to ensure the residents' healthy lives. Therefore, improvement of the quality and accessibility of primary health care posts should be considered as the top priority.

Predicting prediabetes in a rural community: a survey among the Karen ethnic community, Thasongyang, Thailand.

BACKGROUND: Diabetes is a growing epidemic in both urban and rural communities worldwide. AIM: We aimed to survey fasting plasma glucose (FPG) status and awareness of diabetes in the rural Karen ethnic community. We investigated the predictors of impaired fasting plasma glucose (IFG) status, which would be easily applicable for prevention of diabetes in a rural community. MATERIALS AND METHODS: This was a community-based cross-sectional study conducted at Thasongyang, the most north-western district in Thailand. A total of 299 Karen ethnic rural residents were included in the study. FPG, body mass index, and waist circumference were prospectively measured. We assessed the awareness of diabetes and lifestyle-related health behavior with closed questionnaires in a rural community setting. RESULTS: On screening for FPG, 16.72% of the Karen ethnic residents had hyperglycemia: 3.68% in the diabetic range and 13.04% in the prediabetic range respectively. After adjustment for age, sex, and BMI, waist circumference (adjusted odds ratio [aOR] 3.5, 95% confidence interval [CI] 1.29-9.57), and having a diabetic blood relative (aOR 4.6, CI 1.81-11.71) are significant predictors of IFG status. CONCLUSION: It is necessary to promote awareness of diabetes among the Karen ethnic community. Application of simple evidence-based predictors of the prediabetic state may lead to timely and effective prevention of diabetes in rural settings.