Outbreak of Streptococcocus equi Infection in Lampang Province 2011

Abstract

Surveillance Disease Control & Epidemiology unit at Social Medicine Department, Lampang Hospital received notification from Lampang hospital laboratory, finding 4 specimens from inpatients positive cuture for Streptoccocus equi and were confirmed by National Institute of Health, Ministry of Public Health (NIH). This raised the concern for zoonotic epidemic and promt Surveillance Rapid Response Team (SRRT) outbreak investigation. The study was conducted by reviewing medical record, physical examination, history of illness and risk factor, environmental survey and collecting specimen from animal, meat, contact cases meat shops, markets, farms, slaughter houses etc. It was found that there were 14 confirm cases of Streptoccocus equi infection, 6 patients died; fatality rate 42.8 %. Most of them were old age; Median of age were 75.3 year old and had chronic underlying disease. Clinical manifestation were Sepsis/Septicemia 85.7%, Artritis 42.8%, Septic artritis 14.8% and Meningitis 14.28%. Laboratory specimen form patients including Hemoculture, Synovial fluid, CSF were performed. The culture and identification result were positive for Streptoccocus equ subsp.zooepidemicus confirmed by both NIH and Microbiology science department, Chiangmai University. The risk exposed of patients were eating raw meat 85.7% such as raw pork 85.7%, raw beef 57.14%, raw buffalo meat 28.6%. Food meal such as Laab dib(raw chop meat mixed) 85.7%, Luu or Saa (with blood) 85.7%, Naem dib(ferment sausage) 50%. Environmental investigation had no any relation with horse or other animals. The result for laboratory environmental investigation were negative culture for identification of Streptoccocus equi. Disease control measure including strengthening surveillance, survey & examine raw meat commercial, slaughter house should be strengthened. Also active case finding and active health education, improve food sanitation, risk communication in patients community and big campaign about disease getting from raw meat should be promoted. After follow up the outbreak, there were no new cases.