Bacterial etiology of empyema thoracis and parapneumonic pleural effusion in Thai children aged less than 16 years.

This study aimed to identify the bacterial etiology of empyema thoracis or parapneumonic pleural effusions in Thai children, with a focus on pneumococcus. This hospital-based, descriptive study included children aged < or = 16 years, diagnosed with empyema thoracis or parapneumonic pleural effusion, from whom a pleural fluid (PF) sample was taken between January 2008 and November 2009. PF and blood samples were cultured and PF samples were also tested by polymerase chain reaction (PCR) to assess whether evidence of an infection might be identified among culture-negative samples. Serotyping of Streptococcus pneumoniae-positive samples was performed by molecular techniques and Quellung reaction. In this study, 29 children with empyema thoracis and 42 children with parapneumonic pleural effusion were enrolled. Potentially pathogenic bacteria were cultured in 13/71 samples at local or central laboratories; the most common bacteria were Staphylococcus aureus (8 children) and S. pneumoniae (2 children). Molecular techniques detected one or more targeted respiratory pathogens in 18/71 PF samples. S. pneumoniae and Haemophilus influenzae were identified by PCR in 13 and 6 children, respectively; PCR for S. aureus was not performed. The pneumococcal serotypes identified were 1, 3, 5, 6A/B, 9A/V, 14, 15A, 19F and 23A. This study shows that among Thai children with empyema thoracis and parapneumonic pleural effusions, S. aureus and S. pneumoniae were the most common pathogens identified by culture and PCR, respectively. These findings confirmed that molecular techniques are more sensitive for identification of S. pneumoniae and H. influenzae and enhance detection of important bacterial causes of empyema.

Revision of the Thai Red Cross intradermal rabies post-exposure regimen by eliminating the 90-day booster injection.

The Thai Red Cross intradermal post-exposure rabies prophylaxis regimen (TRC-ID) is being used in Thailand, the Philippines, Sri Lanka and is making inroads in India. It consists of two injections of 0.1 mL of any World Health Organization recommended tissue culture rabies vaccine intradermally at two sites on days 0, 3, 7, followed by one injection on days 28 and 90. Two decades of experience had shown that approximately 11% of 187,000 possibly rabies exposed subjects who received the TRC-ID schedule, did not return for the 90-day booster. No rabies deaths had, however, been reported from this group. This stimulated two studies to determine whether the 90-day booster can be abolished. They demonstrated that, if the single 28-day 0.1 mL injection is increased to two at two sites, a comparable antibody response can be achieved and the 90-day booster can be omitted. The tissue culture rabies vaccine used in the preliminary study was purified chick embryo vaccine (PCEC Chiron) and for this study it was chromatography purified Vero cell vaccine (CPRV, Aventis-Pasteur). CPRV had been previously shown to be as immunogenic and effective as purified Vero cell rabies vaccine (PVRV).

Dengue Control through Schoolchildren in Thailand.

Dengue haemorrhagic fever (DHF) was first recognized in Thailand in 1949. Although the morbidity from DHF seems to have stabilized over the past few years, the mortality and case fatality rates have been dramatically brought down. However, DHF remains a crucial public health problem, particularly for young children who are the most affected. After several trials on dengue control, a national dengue control programme was started through the schoolchildren approach in 1992. With a target of reducing DHF morbidity among schoolchildren from 447.8/100 000 to 240/100 000 by 1996, and to 160/100 000 by 2001, the project had achieved the goal of morbidity reduction to 219.2/100 000 pop. by 1996. The project was also evaluated from 96 school samples nationwide during September-November 1994. It was found that 93.7% of the schools sampled had been involved in the project. 62.5% of the provinces and 64.3% of the districts surveyed showed decreasing morbidity rates among both schoolchildren and all other age groups. The majority of both health and education staff had positive attitudes to the objectives and strategies of the project. However, the main constraints were low frequency and non-regularity of the teaching and learning process, lack of consistent supervision from health staff, poor communication and coordination between different organizational personnel and, lastly, insufficiency and irregular and delayed supplies for school support. These weaknesses have been vigorously overcome during the past 2-3 years in order to improve the project implementation.