Disease Control Journal

Outbreak investigation of acute diarrhea in a school of Sao Hai District Saraburi Province

2025-01-28T11:25:53+07:00

An outbreak of acute diarrhea was notified at a school in Sao Hai District, Saraburi Province, from June 19 to 30, 2024. This study aimed to confirm the outbreak, describe the epidemiological characteristics of the patients, identify the causing pathogen and risk factors, and implement the control measures to prevent further spread. Data were collected from medical records of patients treated at Sao Hai Hospital, and a retrospective cohort study was conducted by interviewing teachers, students, and staff about their consumption of food, water, and ice at the school. Laboratory tests were performed on stool samples from patients and food handlers, as well as water and ice samples from the school. The results showed 74 affected individuals, with 38 diagnosed cases (attack rate: 51.35%). Six patients were hospitalized, but no fatalities occurred. Most cases had watery diarrhea (94.74%), vomiting (78.95%), and abdominal pain (73.68%). Laboratory tests identified rotavirus in patient samples, and both rotavirus and norovirus were found in water and ice samples. An analytical study revealed that drinking water from a dispenser near the first-grade classroom was a significant risk factor for developing the illness (Adjusted OR=5.2, 95% CI: 1.3-20.8). The outbreak is likely caused by viral contamination, particularly from the water dispenser. To prevent future outbreaks, it is recommended that the school regularly clean and disinfect the water dispensers.

Outbreak Investigation of Coronavirus Disease 2019 (COVID-19) in A Prison in Chumphon Province, May 3-6, 2024

2025-02-19T17:13:12+07:00

On May 2, 2024, at 4:37 p.m., the Chumphon Provincial Public Health Office reported finding 112 possible cases of coronavirus disease 2019 (COVID-19) in a prison, divided into 69 suspected cases and 43 probable patients. From May 3-6, 2024, a joint investigation team went to the area of the incident to confirm the outbreak, search for infections and identify related factors. A total of 279 cases were identified from April 23 to May 6, 2024, comprising 276 inmates, 2 staff members, and 1 external contact. There were 207 suspected patients, 67 probable patients, and 5 confirmed patients. The patients were aged between 18 and 68 years old with an average age of 37 years. Most of them had symptoms of fever and sore throat (53.85%), runny nose (52.31%), and cough (46.15%). The common risky behaviors for infection were sharing items (69.56%), sleeping closely (44.92%), and doing activities together (10.14%). After randomly collecting samples of 5 inmates who tested positive with ATK, it was confirmed that all samples contained the Omicron strain. Factors affecting the outbreak included overcrowding in the prison (0.91 m2/person). Additionally, outsiders enter prison to engage in activities without testing for ATK before entering and not wearing masks while in prison before the outbreak. Strict adherence to prison COVID-19 surveillance, prevention, and care guidelines is essential to reduce the risk of future outbreaks.

Mass accident investigation: A case of a train hit a bus carrying company employees at passage area, Chachoengsao Province

2024-12-09T10:04:20+07:00

The Joint Investigation Team (JIT) of the Office of Disease Prevention and Control, Region 6 Chonburi and the multidisciplinary team in Chachoengsao Province investigated a mass accident between a train and a bus carrying company employees at a passage area in Chachoengsao Province, resulting in multiple fatalities. This investigation aimed to (1) describe the epidemiological characteristics of the injured and fatalities, (2) identify factors affecting injuries and fatalities, and (3) develop policy recommendations for preventing accidents in the future using the Haddon,s Matrix. The investigation results revealed that the accident occurred on October 11, 2020, resulting in 18 fatalities. Factors leading to the accident were described as human factors, vehicle factors and area-based factors. In terms of human factors, the bus driver was unfamiliar with the route and most passengers were not wearing seatbelts. A party with alcoholic beverages on the bus was reported and resulted in injuries and fatalities. Regarding vehicle factors, the bus was 12 years old, had been modified, and was overloaded with more passengers than the specified capacity. Due to the train being loaded with goods, it was not able to stop suddenly, resulting in a severe collision. In terms of area-based factors, the accident site was a passage area with no barriers, an uneven area, and trees covering the area, which obstructed visibility. Therefore, the Provincial Road Safety Center and relevant agencies should identify passage areas and railway intersections where accidents occur frequently and solve the problems. The bus operators should regularly check the condition of their buses. and the competent authority must ensure that the law on vehicle inspection is strictly enforced. Additionally, creating awareness of road safety among travelers and publicizing or warning of unusual road conditions should be implemented. The result of the cooperation of multidisciplinary team in this area has resulted in the railway barrier at the passage area, which was unofficially opened in February 2024.

An outbreak investigation of silicosis among granite carving workers in Wihan Daeng District, Saraburi Province

2025-03-04T10:09:13+07:00

The Situational Awareness Team (SAT) of the Department of Disease Control was notified by the Office of Disease Prevention and Control Region 4, Saraburi, on November 18, 2022, that two patients diagnosed with silicosis were receiving treatment at Saraburi Hospital. The outbreak investigation was later conducted on November 22, 2022, to confirm the diagnosis, identify the causes of the disease, find additional cases, assess the work environment, and establish preventive measures for silicosis. The
investigation consists of descriptive epidemiological study by reviewing patient medical records at healthcare facilities, active case finding and walkthrough survey in the workplace, and measuring silica dust levels in the workplace environment by following the National Institute for Occupational Safety and Health (NIOSH) Methods No. 7601. Data analysis was conducted using descriptive statistics. Two confirmed cases were found from the investigation. Both patients have worked as stone carvers for over 20 years and usually they are not consistently using appropriate personal protective equipment (PPE) during work. The active case finding reveled five more patients from this workplace in the past five years, all of them have died. From the walkthrough survey, there were 10 people working in the same process as confirmed cases, who had been exposed to silica dust for over five years. Half of them developed symptoms, such as chest tightness and difficulty breathing. The walkthrough survey in the workplace demonstrated that the work process like stone carving has contributed to dispersion of silica dust as confirmed by a measurement of silica dust in workplace environment, with 6 out of 8 workplace environmental samples (75%) containing silica dust levels that exceed the standard limit. Additionally, not wearing or using PPE properly was one of the main risk factors contributing to this outbreak. Reducing the dust level by engineering control, e.g. by using specialized cutting or grinding tools, water curtain, and improving ventilation, was the proper recommendation for disease control measures in this setting. Moreover, workers should also be encouraged to consistently and properly use standard PPE to reduce the risk of developing silicosis. An annual health examination based on the risks should be conducted for detection of early stages of silicosis. Lastly, assessments of silica dust levels in the workplace should be performed regularly to ensure the safety of the workplace environment.

Hepatitis A outbreak: A threat of untreated tap water in school, Sungai Kolok District, Narathiwat Province, Thailand

2025-03-04T10:33:48+07:00

On November 12, 2023, a cluster of hepatitis A (HAV) infected students and personnel in a primary school in Sungai Kolok District was notified. We investigated the causes of the outbreak and risk factors to establish and implement control measures. Both retrospective cohort, descriptive and analytical epidemiological studies including environmental investigation were conducted. Active case finding was performed. A case was defined as a person in the school who has at least two symptoms of jaundice, fever, dark urine, loss of appetite, fatigue, nausea or vomiting, abdominal pain, dyspepsia, epigastric pain, and right subcostal pain between June 1, 2023 and April 5, 2024. Stool samples were tested for hepatitis A virus genetic materials and HAV genotype, while serum samples were tested for anti-HAV IgM. In addition, water supply, drinking water, and ice samples were tested for free chlorine, coliform bacteria, hepatitis A virus, and HAV genotype. We found 26 cases with illness onset occurring between July 29, 2023 and December 27, 2023, resulting in an overall attack rate of 15.2% (26/171). The affected individuals were aged 7 to 29 years (median 11 years). The water supply was from the untreated shallow well near the septic tank. No soap was provided and 94% of students and staff did not wash their hands after using the bathroom and before eating. Moreover, it was found that 69.6% abluted themselves using untreated tap water before praying and 21.1% swallowed it while rinsing their mouth. Laboratory results detected anti-HAV IgM and hepatitis A virus genotype IA in patients, which are consistent with the strain found in the water supply. Additionally, no free chlorine was present in the water supply, and coliform bacteria were detected in both the water supply and drinking water samples. Analytical studies did not identify statistically significant risk factors. Chlorine tablets, clean water, and soap were temporarily provided. Since establishing a permanent treated water supply in January 2024, no cases have been reported. The cause of the outbreak is likely from untreated water supply and poor hygiene. Improving water quality, sanitation, and hygiene is crucial for preventing future outbreaks.

Development and driving of the national disease and health hazard prevention and control plan towards a robust disease and health hazard prevention and control system

2025-02-19T13:19:47+07:00

The qualitative study aimed to analyze the review and development process of the 20-year national development plan for the prevention and control of diseases and health threats (2018-2037), revised version 2021, and the second phase of the national action plan, the strengthening phase (2023-2027). The study also examined the mechanisms for implementing the action plan, identified key success factors and obstacles, and provided policy and practice recommendations to facilitate the development and advancement of the plan toward a robust system of disease and health threat prevention and control. A mixed-method qualitative approach was adopted, integrating document reviews, secondary data analysis, and engagement in meetings with purposefully selected key stakeholder groups. The findings revealed that three critical processes were Identified: preparing the relevant information, communicating the conceptual framework and methodologies for reviewing and improving the plan to key stakeholders, and organizing the plan review and improvement process through the application of strategic foresight framework. The mechanisms to drive the action plan into practice existed which included policy and legal mechanisms, technical mechanisms, management mechanisms, and monitor and evaluation mechanisms. The need to strengthen the linkage of information on disease prevention, control, and health threats with both internal and external networks as well as the lack of evaluation regarding the efficiency of these mechanisms in driving the plan forward should be highlighted. For policy recommendations, the formulation of strategies, especially in areas of disease prevention and control and health threats, should emphasize the use of technology and analytical tools to manage big data. This is to design responsive disease prevention and control service systems to meet public needs and ensure preparedness for future challenges. For practical recommendations, the integration of multiple principles under PDCA cycle should be employed to guide the development of sustainable implementation mechanisms and the initiation of a sandbox project for innovation

Situation of public health emergency management in Health Region 5

2025-01-28T11:40:00+07:00

Climate and environmental changes globally have significantly impacted disasters and public health emergencies worldwide, including the Health Region 5. No evident study has been undertaken on public health emergency management situation in Health Region 5. This study was conducted to examine the pattern of the public health emergency management system in Health Region 5 and to provide recommendations for system improvement clearly and systematically. The mixed methods, including quantitative and qualitative studies, was adopted. The quantitative study was completed through a constructed questionnaire to evaluate the readiness of the emergency management system. The qualitative study included document review and interview. For document review, the reports on Emergency Operations Center (EOC) assessment tools from 2021-2023 of Health Region 5, the after-action review reports on public health emergency management during the COVID-19 pandemic of Health Region 5, and the after-action review reports on public health emergency management of the Office of Disease Prevention and Control, Region 5 Ratchaburi were analyzed. For the interview, 42 key stakeholders were recruited, including executives and relevant health personnel. The results revealed that both quantitative and qualitative results were consistent and showed that health systems in terms of public health emergency management system, data and information, and leadership and governance had highly appropriate management. However, limited resources were caused by healthcare expenditures and the inadequate number of health workers. Therefore, clear budget allocation plans, expenditure guidelines, and effective workforce planning are essential. For key technical areas requiring further development, operational framework development, resource identification for additional needs, and regular business continuity plan exercises are all necessary.

Health literacy, medication adherence, and preventive behaviors of patients with pulmonary tuberculosis at the Chest Disease Institute

2025-01-28T11:35:22+07:00

This descriptive cross-sectional study aimed to assess health literacy, medication adherence, and preventive behaviors related to the transmission of pulmonary tuberculosis (TB) patients. A total of 133 newly diagnosed pulmonary TB patients with sputum-positive results who were undergoing treatment for drug-susceptible TB at the pulmonary tuberculosis clinic of the Chest Disease Institute during February and April 2020 were included into the study. Data was collected through interviews, which included questions about personal information, health literacy, medication adherence, and preventive behaviors related to TB transmission. The questionnaire demonstrated acceptable reliability, with Cronbach's alpha coefficients of 0.767, 0.841, and 0.766 for the respective domains. Data was analyzed using descriptive statistics. The 51.1% of participants were female, with a mean age of 45.83 years. Among them, 39.8% had attained a bachelor's degree, and 37.6% were employed in daily wage jobs. Regarding health literacy, the findings showed that participants had a high level of health literacy (mean=3.15, SD=0.48). Similarly, medication adherence was reported at a high level (mean=4.60, SD=0.67). Preventive behaviors related to TB transmission were also high among the participants (mean=4.35, SD=0.47). In conclusion, patients with pulmonary TB demonstrated high levels of health literacy, medication adherence, and preventive behaviors against disease transmission. However, there is a need to further enhance education on seeking reliable health information, utilizing medication reminders, supporting regular exercise, and improving environmental conditions to reduce disease transmission in the community.

Development of prototype schools for environmental risk prevention based on the concept of "clean air, safe food, and well-maintained buildings”

2025-02-19T13:22:15+07:00

This study aimed to develop prototype schools designed to prevent environmental pollutants, such as PM2.5, asbestos, lead, and pesticides, using a research and development approach. The study was divided into 4 phases: phase 1 situation analysis, assessing existing school initiatives to address environmental issues; phase 2 guideline development, developing operational protocols for target schools; phase 3 implementation, launching the guidelines in selected schools; and phase 4 evaluation, measuring outcomes and effectiveness. Data collection included focus group discussions, observations, and document reviews, using discussion guides and performance evaluation forms. Content analysis and descriptive statistics were employed for data analysis. In Phase 1, 29 participants from 23 schools participated online focus group discussions. Most schools reported engaging in farming activities, they highlighted knowledge gaps in lead and asbestos prevention. From Phase 2 to Phase 4, 6 key components for prototype schools and 4 measures for environmental pollution prevention were established based on 22 criteria. A total of 21 schools from across the country participated in the implementation phase, most of which were from kindergarten to lower secondary levels. An analysis of the implementation for each measure revealed that all schools completely implemented measures to prevent PM2.5. Measures to prevent asbestos and pesticide exposure were achieved by at least 19 schools, while measures to prevent lead contamination were adopted by at least 18 schools. Notably, innovative solutions were developed by 8 schools to enhance their preventive measures. The evaluation showed that all participating schools achieved over 70% compliance with the established measures. The Department of Disease Control, in collaboration with the Ministry of Education, is currently working to extend these initiatives to a wider range of schools.

Child drowning health literacy and child drowning prevention behavioral of households in Khao Samsib Sub-district, Khao Chakan District, Sa Kaeo Province

2024-12-19T16:32:32+07:00

Child drowning is the leading cause of death in children under 15 years old. This cross-sectional study aimed to investigate the health literacy related to drowning prevention in children and its associated with drowning prevention behaviors among caregivers of Khao Samsib Subdistrict, Khao Chakan District, Sa Kaeo Province. A total of 291 households were randomly recruited into the study. Household representatives were interviewed using structured questionnaire. The content validity index (CVI) values for individual items (I-CVI) and the scale (S-CVI) ranged from 0.83 to 0.97. Reliability was assessed using Cronbach's alpha. The reliability coefficient of knowledge and skills in preventing drowning in children were 0.72 and 0.74, health literacy in preventing drowning in children was 0.82, and household behaviors in preventing drowning in children was 0.74. Descriptive statistics and chi-square tests were used to analyze the data. The study found that 52.9% of household representatives were at a sufficient level of knowledge about drowning prevention. About half were at a sufficient level of decision-making skills, implementation, and information access (53.6%, 52.6%, and 51.9%, respectively). However, understanding and inquiry skills were at an insufficient level (52.9% and 50.2% respectively). Drowning preventive behaviors, 80.5% was at a good level and 83.8% was at a low level of knowledge on drowning prevention. Skills related to drowning prevention, 85.1% was at good level. Educational status, and knowledge of drowning prevention were significantly associated with drowning preventive behaviors (p-value<0.05). To prevent drowning and deaths from drowning in children, activities should be organized to promote health literacy and enhance knowledge of proper resuscitation techniques among community people.

Knowledge, attitudes, and preventive behaviors towards COVID-19 among pharmacy students in Bangkok Metropolitan Region: a A correlational Study

2025-02-03T10:41:53+07:00

This survey research aimed to investigate the relationships between knowledge, attitudes, and preventive behaviors towards COVID-19 among pharmacy students Total of 340 pharmacy students from 8 universities in the Bangkok Metropolitan Region were included into the study via online questionnaire between January and March 2022. Descriptive statistics and Spearman's rank correlation coefficient were used for data analysis. The results showed that 51.2% of participants were female with a mean age of 21.32±2.03 years, and 52.9% were enrolled in the pharmaceutical science program. Social media was the primary source of information about COVID-19 (95.5%). The students demonstrated a very high level of knowledge about COVID-19 (mean score 13.44±2.77 out of 15), a good level of attitudes (mean score 3.92±0.47 out of 5), and a good level of preventive behaviors (mean score 2.04±0.48 out of 3). Knowledge was positively correlate with attitudes (r=0.165, p<0.05), and attitudes was also positively correlate with behaviors (r=0.641, p<0.05). However, no significant correlation was found between knowledge and behaviors. These findings suggest that fostering positive attitudes may be more important than providing knowledge alone in changing preventive behaviors, especially among health science students who already have a high level of basic health knowledge. This study provides fundamental information for future research on health behaviors among health science students.

Situations and factors associated with SARS-CoV-2 infection during 2022-2024 and forecasts of the number of patients undergoing SARS-CoV-2 test at Rajpracha Samasai Institute during 2024-2025

2025-03-04T10:25:41+07:00

Although the Thai Government has officially declared the end of the COVID-19 pandemic, Rajpracha Samasai Institute still detects cases of SARS-CoV-2 infection. This study aimed to (1) examine the number of individuals undertaking SARS-CoV-2 testing and individuals infected with COVID-19 at Rajpracha Samasai Institute from October 1, 2022, to May 31, 2024, (2) identify factors associated with SARS-CoV-2 detection, and (3) forecast the number of individuals seeking SARS-CoV-2 testing from June 1, 2024 to January 31, 2025. This study utilized a time-series cross-sectional dataset and analyzed data from 1,801 individuals using descriptive statistics. Binary logistic regression was applied to assess infection-related factors. Forecasting models including seasonal autoregressive integrated moving average (SARIMA), seasonal exponential smoothing (SES), and a 3-month moving average (3-MA) were conducted. The results showed that 28.2% of individuals tested positive for SARS-CoV-2 (42.8%, 24.9%, and 23.6% in 2022, 2023, and 2024, respectively). Being female, aged 18 years or older, having cough, and experiencing fever were significantly associated with a positive SARS-CoV-2 test result. Forecasting results indicated that the estimated number of individuals seeking testing would be approximately 90 and 70 per month based on the SES and 3-MA models, respectively. The SARIMA(0,0,0)(0,1,0)12 model predicted monthly variations ranging from 37 to 123 cases. Nonetheless, some limitations remained such as the absence of risk information from communities or immunity level, and the relatively short timeframe of the dataset used for forecasting. However, the findings can be useful for appropriate resource allocation and planning for SARS-CoV-2 testing services at Rajpracha Samasai Institute in the future.

Health literacy and preventive behaviors against rabies among residents of Chuen Chom District, Maha Sarakham Province, 2023

2025-02-19T13:37:13+07:00

This cross-sectional descriptive study aims to assess the level of health literacy among residents in areas with continuous rabies outbreaks in animals and reported human bite cases in Chuen Chom District, Maha Sarakham Province. The study was conducted using a questionnaire with a sample of 215 participants. The study found that 90.2% of the respondents were female, and 61.8% were aged 51 years and older. Regarding education, 75.3% had completed secondary school, vocational certificate, or diploma levels. Overall, 38.6% of the participants had an insufficient level of health literacy, with decision-making skills being the most problematic area. In terms of rabies knowledge, 49.8% had a moderate level, while 33.0% had a very good level of understanding. Regarding rabies prevention behaviors, 67.4% demonstrated excellent preventive practices. The most common source of rabies prevention information was healthcare personnel (81.4%). The findings highlight the urgent need to enhance rabies-related health literacy among the public. Public health agencies, in collaboration with relevant networks, should establish accessible and accurate information databases. Recommendations: 1) Improve all five aspects of health literacy among residents in high-risk areas; 2) Increasing rabies prevention campaigns in order to correct common misconceptions about rabies, such as the belief that all rabid dogs are aggressive and that rabies is a curable disease.

Prevalence, implementation of preventive measures, and associated risk factors of hand, foot and mouth disease in early childhood development centers in Ban Du Subdistrict, Mueang District, Chiang Rai Province

2025-02-24T14:44:31+07:00

The incidence of hand, foot, and mouth disease (HFMD) in Thailand, particularly Chiang Rai province, is on an upward trend and the HFMD outbreaks mostly occur in early childhood development centers, most notably among children aged under 5 years, the most susceptible group. Factors contributing to the outbreaks of HFMD include personal hygiene of children, parents, and child caregivers in the centers, as well as hygiene practices and environmental management in early childhood development centers, which generally are required to follow the quality standards of the Department of Disease Control, Thailand Ministry of Public Health. This study aimed to determine the prevalence and identify factors associated with HFMD in Ban Du Subdistrict, Mueang District, Chiang Rai Province. A cross-sectional analytical study was conducted to collect the data using questionaries, environmental investigation was performed using the environmental checklists. A total of 389 parents, 49 child caregivers, and 11 early childhood development centers were included into the study. Descriptive statistics, which included number, percentage, and mean and standard deviation, and the following inferential statistics: chi-square tests and multiple binary logistic regression were applied to identify association between variables. The prevalence of HFMD was 26.7%. Factors associated with the transmission of HFMD were household incomes, primary caregivers, number of children in the household, level of parental knowledge and preventive behaviors on HFMD. Having two or more children in the household had 1.85 (95% CI=1.07-3.21) times greater odds of getting HFMD than those individuals who have one child. Environmental assessments of the 11 early childhood development centers revealed that 63.6% met the required standards. In the meantime, those non-compliant centers still continuously report HFMD cases every year. The prevalence of HFMD in early childhood development centers of Ban Du Municipality is high. Children whose families had higher incomes and grandparents served as primary caregivers were more likely to HFMD infection. Early childhood development centers should be continuously evaluated to prevent the outbreak of HFMD.

Health perception and hand hygiene practices among Thai passengers in Suvarnabhumi International Airport

2025-02-24T14:41:36+07:00

Promoting hand hygiene in public places is extremely challenging, especially in airports, which are travel hubs where travelers worldwide come together. This creates an environment conducive to the spread of various infectious diseases through numerous shared surfaces. This exploratory research aims to assess health perceptions and hand hygiene practices and identify the relationship between perceptions and hand hygiene practices of Thai passengers at Suvarnabhumi International Airport. The sample group consists of 72 Thai passengers, both inbound and outbound. Data was collected using a questionnaire developed by applying the concept of the Health Belief Model. The data were analyzed using descriptive statistics and probit regression analysis. The study results showed that the perception of hand hygiene benefits was at a 'very high' level. The perception of the risk of contracting diseases and the severity of diseases are at a 'high' level. The perception of hand hygiene barriers is at a relatively low level and does not hinder hand hygiene performance. The perception of health motivation is at a 'high' level. Thai passengers reported “always” and “frequently” performed hand hygiene in 6 situations, including after using the toilet (94.5%), before eating (79.1%), after leaving the airplane (57.0%), after passing through the security check (51.4%), before boarding (45.8%), and before passing through the security check (45.8%). Water with soap and Alcohol hand rub are mostly used to perform hand hygiene. The duration for each hand hygiene performance is around 5-15 seconds. The perception of the risk of contracting diseases, the perception of the severity of diseases, the perception of hand hygiene benefits, the perception of hand hygiene barriers, and the perception of health motivation were significantly associated with hand hygiene performed before passing through the security check (p-value=0.02) and after passing through the security check (p-value=0.04). The low perception of hand hygiene barriers was associated with the relatively high frequency of hand hygiene performed before and after passing through the security check. However, significant association between health perception and motivation and hand hygiene performed before eating, before boarding, before leaving the airplane, and after using the toilet were not found (0.09<p-value<0.87). The findings of this research can be used as guidance for improving facilities and environmental arrangements and providing alcohol gel stations for hand hygiene purposes that effectively reach travelers. This would contribute to promoting good health behaviors, which would benefit the target population by helping reduce the incidence of the spread of pathogens through contact with various environmental surfaces within the airport, both in the present and in the future.