Disease Control Journal

A case of hypersensitivity pneumonitis in a woodworker: diagnostic challenges and management

Patrawan Wanasathop — 2024-12-19

Hypersensitivity pneumonitis (HP), also known as extrinsic allergic alveolitis, is an inflammatory lung disease caused by an immune response to environmental antigens. This case report emphasizes the importance of taking an exposure history in a 68-year-old Thai male patient with a history of recurrent pneumonia. Radiological examination revealed multifocal ground-glass opacities, consolidation, and mosaic attenuation, along with bronchoalveolar lavage (BAL) showing lymphocytosis without evidence of infection, autoimmune disease, or lung cancer. The patient's work history revealed a hobby in woodworking with long-term exposure to wood dust and chemicals without proper personal protective equipment (PPE). The patient was diagnosed with non-fibrotic HP. After ceasing woodworking and receiving inhaled corticosteroids (ICS), the patient showed improvement and did not experience recurrence. Follow-up radiological exams and pulmonary function tests showed progressive improvement. Diagnosing HP is challenging due to its varied and nonspecific clinical features. Woodworking poses a risk for HP due to exposure to wood dust, fungi, and chemicals. Implementing a hierarchy of hazard control management can effectively reduce exposure and prevent HP and other occupational diseases.

Investigation of influenza A (H3) outbreak in a scout camp Pathumrat District, Roi Et Province, Thailand, February 2023

Apinya Duangkaew — 2024-12-19

An outbreak investigation of Influenza A (H3) in a scout camp in Pathumrat district, Roi Et province, February 2023, aimed to confirm the diagnosis of the outbreak, identify the causes or risk factors associated with the outbreak, and determine control and prevention measures. The study employed a descriptive and analytical epidemiological approach, utilizing a retrospective cohort study design. An active case finding was conducted using a case investigation form. Based on a case definition that refers to students or teachers exhibiting at least two symptoms (fever, cough, sore throat, runny nose, headache, muscle aches) from February 1 to February 13, 2023, the additional cases were identified and the environmental investigation were conducted. Throat swabs were collected for laboratory confirmation. From a total of 247 students and teachers, 163 cases met the case definition, resulting in an attack rate of 65.99%. There were 7 confirmed cases of Influenza A (H3) out of 7 samples tested, and 156 were suspected cases. The attack rate, by gender, 76.29% in male and 53.57% in female. The minimum age was 9 years and the maximum age was 60 years (median age of 13 years). The rate of illness was classified by age group: 5-9 years old (100%), 10-14 years (73.67%), 15-19 years (60.00%), 20-24 years (0%), and 25 years or older (27.27%). The most common symptoms were cough (88.34%), runny nose (73.01%), fever (64.42%), sore throat (55.21%), and headache (46.01%). No severe cases or deaths were reported. Sharing drinking glasses with others was identified as a significant risk factor for the outbreak (AOR=3.32, 95% CI=1.47-7.50). Wearing a mask was found to be a protective factor (AOR=0.46, 95% CI=0.26-0.80). The outbreak was cause by influenza A (H3). Effective control measures and public health education regarding influenza were implemented which included stop sharing things with others, wearing a mask, screening and isolating symptomatic students, and allowing sick students to stay home. Therefore, the outbreak was effectively controlled and contained.

An outbreak of influenza a H3N2 in a prison, Krabi Province, Thailand, August, 2023

Kalita Wareewanit — 2024-12-19

The outbreak of influenza tends to increase every year, especially in prisons where several outbreaks have occurred. On 15 August 2023, a joint investigation team received a notification that there was a cluster of influenza-like illness (ILI) cases more than 100 cases in a prison, Krabi province. We investigated the outbreak to confirm the diagnosis and its epidemiology, to evaluate the magnitude of outbreak, to identify causes and mode of transmission, and to implement the effective control measures. A descriptive study was conducted and active case finding was performed. Suspected cases were defined as any prisoner or staff member of the prison who had at least 2 of the following symptoms: fever, cough, sore throat, runny nose, headache and muscle pain during 7-19 August 2018. We collected the samples for real-time RT-PCR and whole genome sequencing, and calculated the capacity of the prison cell. Total of 325 cases were met case definition (attack rate 26.1%): 35 of 39 probable cases (89.7%) were confirmed positive for influenza A H3N2 by RT-PCR. Whole genome sequencing analysis revealed that all 7 cases were genetically linked with a substrain called A/Darwin/9/2021(H3N2)-like strain. Male prisoners had the highest incidence rate at 29.2%. The effectiveness of the influenza vaccine against clinical influenza was 39.4%. The outbreak began when a staff member got sick and spread to the prisoners. Risk behaviors that lead to disease transmission were identified as staying close to patients (76.6%), doing activities together with patients (70.5%), and sharing items with patients (44.0%). The prison cells have a capacity rate below the standard (area<1.6 sq.m/person) at 47.4%. We implemented the measures to stop the transmission of the disease, which included screened for new cases every day and immediately isolated patients, stopped activities in the prison, stopped family visits, increased the frequency of cleaning, encouraged to wear masks, and immediately prescribed oseltamivir for the patients.

Viral hepatitis B and C screening by collaboration of local administrative organization, 2022-2023

Cheewanan Lertpiriyasuwat — 2024-12-19

In Thailand, it was estimated that there were approximately 2.2 million chronic hepatitis B cases and around 300,000 to 400,000 chronic hepatitis C cases in 2014. There are a significant number of infected individuals who have no access to services because they are unaware of their infection. Division of AIDS and STIs (DAS), Department of Disease Control, implemented a hepatitis B and C screening project to enhance participation of local administrative organizations (LAOs) in support of targeted population to access to services. This article aims to present the project performance results during October 1, 2021-September 30, 2023. The DAS supported HBsAg and Anti-HCV rapid test kits for targeted populations born before 1992 or having risk of hepatitis B and C infection in 76 provinces. Local staff collected data by using a report form and recorded in a computer program. Data analysis used descriptive statistics. The results found that there were 43,402 and 138,594 persons screened for hepatitis B, 46,572 and 146,823 persons screened for hepatitis C in fiscal year 2022-2023, respectively; the mean ages were 49 years and 52 years, respectively. Of these, 2.42% and 2.43% of participants tested positive for HBsAg, and 0.76% and 1.34% of participants tested positive for HCV antibody, respectively. Among anti-HCV positive participants, 14.97% and 36.15% were tested HCV Viral load and 69.81% and 52.32% of them were detected, respectively. For collaboration with LAOs, most of LAOs supported their personnels and places for screening service, including service public relations. Some LAOs supported their budget for screening. We recommend promoting awareness of people and local networks to danger of hepatitis B and C diseases to increase service accessibility, mobilizing resources and sustainable collaboration, including developing referral system for infected persons to treatment.

Coverage and factors associated with Dual COVID-19 and influenza vaccination among health volunteers in Health Region 9

Prangnapitch Wihanthong — 2024-12-19

Influenza and COVID-19 are vaccine-preventable diseases that often occur during the rainy season. In 2023, the Ministry of Public Health implemented a policy to concurrently administer COVID-19 and seasonal influenza vaccines (Dual Vaccination Campaign). This study aimed to study the coverage and factors influencing the uptake of the dual vaccines made available among public health volunteers in Health Region 9. This study is a rapid, descriptive cross-sectional study. Data was collected by interviewing 18,074 public health volunteers in Health Region 9 between September 14 and October 19, 2023. The coverage rates for influenza and COVID-19 vaccines were 70% and 96.9%, respectively. The rate of receiving both the COVID-19 and influenza vaccines concurrently was 12.1%. Factors significantly affecting the uptake of dual vaccination included male, increasing age, increasing education level, and chronic diseases according to the criteria for receiving COVID-19 and influenza vaccines. Perception factors influencing vaccination uptake included risk of illness perception and risk of severity perception. Motivational factors included awareness of policies, the awareness that the influenza and COVID-19 vaccines can be administered concomitantly, government promotion of dual vaccination, health care providers offering dual vaccination, availability of free influenza and COVID-19 vaccinations, and the government's provision of sufficient vaccine supplies. The seasonal influenza and COVID-19 vaccination coverage among public health volunteers in Health Region 9 was in line with national policy. However, it is necessary to promote the concurrent administration of dual vaccines. In addition, it is also necessary to raise awareness about the risk of disease outbreaks, severity of diseases, and national policy, supporting the free vaccines, ensuring sufficient vaccine supply, and encouraging service units at all levels to offer the dual vaccine service since these combined efforts will help the target group access vaccines correctly.

Tdap vaccination among pregnant women in Phatthalung Province (pilot project)

Prangnapitch Wihanthong — 2024-12-19

Giving the pertussis vaccine to pregnant women is an essential precaution to prevent pertussis in newborns. Immunity to pertussis is transferred from the mother to the fetus, resulting in newborns having immunity against pertussis. In 2020, the Department of Disease Control, in collaboration with the Phatthalung Provincial Health Office, piloted the administration of one dose of Tdap vaccine to pregnant women. This pilot aimed to assess the feasibility and appropriateness of providing this vaccine. This study aims to evaluate the implementation of the Tdap vaccination program for pregnant women in Phatthalung Province. This study is descriptive cross-sectional study. Data was collected using questionnaires distributed to health care workers at the Phatthalung Provincial Health Office and 11 hospitals between January 12 and 26, 2024. The results showed that district vaccine warehouses and vaccination units followed the immunization program's cold chain guidelines. Vaccination services were successfully integrated into mother and child health programs. The Tdap vaccine was accepted by both healthcare staff and pregnant women, and no serious adverse events following immunization were reported. Providing the pertussis-containing vaccine to pregnant women enhances the immunity passed from the mother to the fetus, which results in babies becoming immune to pertussis. Thailand provided a pertussis-containing vaccine for pregnant women. In 2024, delivering one dose of the aP vaccination for each pregnancy is considered a maternal entitlement.

Situation of Surveillance, Prevention and Control Emerging Disease in Health Region 5

Rapeepan Phothong — 2024-12-19

The rapid changes in global economics, politics, society, and climate have contributed to the increase of emerging diseases, as evidenced by the pandemic of COVID-19. Health Region 5 is an area that is at risk for emerging diseases. This study aimed to analyze emerging disease surveillance, prevention, and control in Health Region 5 and provide recommendations for effective implementation of the surveillance system. Mixed method was conducted, including quantitative and qualitative studies. Qualitative data were collected through document review and in-dept interview. For document review, documents of the Office of Disease Prevention and Control 5, Ratchaburi Province, during the year 2024, documents on emerging disease surveillance, documents on syndromic surveillance, assessment reports based on standards and operational guidelines for situation awareness teams and joint investigation teams. were analyzed: For in-dept interviews, 37 key stakeholders were recruited, including executives, directors, and other relevant personnel. The quantitative results revealed that the health information system, disease surveillance, prevention and control, leadership, and governance were rated as highly to most highly appropriate compared to other components. The qualitative results showed that 1) emerging disease surveillance, prevention, and control were implemented in the existing system of general infectious diseases, and syndromic surveillance remained in operation, but no dedicated laboratory surveillance had been implemented specifically for emerging diseases in the region; and 2) surveillance and health information systems were appropriate, but the budgets were limited. Therefore, Health Region 5 should establish specific plan for emerging disease surveillance and control. The laboratory surveillance should be implemented. The coordination mechanisms should be enhanced, as well as the ongoing training of health personnel on emerging diseases. Additionally, the improvement of information systems through digital technology, and increased budget allocation should be managed to improve the performance of the system.

Evaluation of insecticide aerosol sprays as positive controls for bioefficacy against Aedes aegypti, Musca domestica and Blattella germanica

Chayada Khamsawads — 2024-12-19

Quality control of test results is one of the components of quality assurance in laboratories, ensuring that the test results are accurate and reliable. The objective of this study was to evaluate the efficacy of three formulations of insecticide aerosol sprays (labeled A, B, and C), which were selected as a positive control. Formulation A contained cypermethrin 0.20% w/w and imiprothrin 0.15% w/w, formulation B contained cypermethrin 0.15% w/w, imiprothrin 0.10% w/w and transfluthrin 0.10% w/w, and formulation C contained cypermethrin 0.20% w/w, imiprothrin 0.15% w/w, transfluthrin 0.10% w/w and d-tetramethrin 0.10% w/w. The bioefficacy of three formulations were conducted against laboratory strains of Aedes aegypti and Musca domestica using the glass chamber method, and Blattella germanica using the surface contact method. The results showed that all three formulations passed the requirement of bioefficacy tests, with no significant differences in mortality in all insect species. It was concluded that high efficacy was observed in all three evaluated formulations. However, since formulation A contained only two active ingredients, it was more convenient to prepare than formulations B and C. The efficacy of formulation A was then evaluated in ten generations of the three-insect species. The results showed that the mean mortality rates of Ae. aegypti, M. domestica and B. germanica were 100%, 98.50% (SD=2.14) and 100%, respectively. Therefore, formulation A was appropriate for use as a positive control in the bioefficacy test of aerosol insecticide products to evaluate and confirm the results obtained from the laboratory tests. Quality assurance enhances customer’s confidence in the test reports, which will be used to apply for registration with the Thailand Food and Drug Administration (FDA).

Effectiveness of medication refilling system for hypertensive patients in a primary care unit, Mueang District, Phetchabun Province, Thailand: A propensity score matching analysis

Tassana Thammaros — 2024-12-19

This observational, retrospective, cross-sectional study aimed to evaluate the effectiveness of a medication refilling system for hypertensive patients in a primary care unit in Mueang District, Phetchabun Province, Thailand. A total of 500 medical records of patients attending the primary care unit of Phetchabun Hospital during January 1, 2022-September 30, 2023 were reviewed. Patients were categorized into two groups: those receiving standard treatment and those receiving medication refills. The propensity score analysis using the nearest neighbor matching method was used to control the confounding factors. Descriptive statistics were utilized to depict the number and percentage of demographic data, health status, and risk behaviors. Chi-square tests were employed to examine differences in categorical variables. Univariate and multiple binary logistic regression analyses were conducted, with a significance level set at p-value<0.05. As a result of propensity score analysis, 188 pairs of matched patients who received either standard treatment or medication refills were included into this study. Simple binary logistic regression analysis indicated that the following variables including receiving medication refills, not sufficiently controlling blood pressure before clinic visits, and alcohol consumption were significantly associated with uncontrolled hypertension, with odds ratios of 1.61, 1.59, and 1.70, respectively (p-value=0.03, 0.04, and 0.03). However, from multiple binary logistic regression analysis, variables significantly associated with uncontrolled hypertension were not identified. In conclusion, the medication refilling system for hypertensive patients in a primary care unit was equally effective in controlling blood pressure compared to standard care, despite a higher likelihood of uncontrolled blood pressure. Enhancements to the medication refill system may further improve its effectiveness. Future studies should focus on refining blood pressure measurement processes and ensuring accurate recording of blood pressure values to minimize discrepancies.

Study of triglyceride glucose index and triglyceride-HDL ratio in diagnosis of diabetes mellitus type 2

Chanin Prakongyot — 2024-12-19

The aim of this study is to determine whether the diagnostic accuracy of TyG index or TG/HDL ratio is significant in the diagnosis of T2DM. This study is a retrospective cross-sectional study. The population of interest was people aged 18 years or older who received hospital services from January to December 2023. We collected the data from medical E-database including characteristics of sample and medical history. We compared the capability in diagnosis of T2DM using statistical analysis: sensitivity, specificity, positive predictive value, negative predictive value and AUC-ROC. The results indicated a total of 8,464 cases, 47.31% were males (4,004 cases) with the mean age 61.70 years (SD=13.96). The T2DM prevalence is 32.21% (2,726 cases). The diagnostic accuracy of TyG index (cut-off point: 8) had a sensitivity of 95.78%, a specificity of 13.56%, PPV of 34.49%, NPV of 87.12% and AUC-ROC of 54.67%. For the TG/HDL ratio (cut-off point: 3), the diagnostic accuracy revealed a sensitivity of 40.68%, specificity of 73.74%, PPV of 42.39%, NPV of 72.35% and AUC-ROC of 57.21%. The findings show that TyG index and TG/HDL ratio are not suitable for diagnosing T2DM. Considering adjusting the cut-off points could improve the accuracy of these tools for screening or diagnosing the disease.

The effects of diabetes foot prevention program on the knowledge and behaviors of foot care and foot health among the elderly with type 2 diabetes mellitus in a Public Health Service Center

Nattanan Wattanawikan — 2024-12-19

This controlled nonrandomized nonclinical trial (CNNT) research aimed to examine the effects of the diabetic foot prevention program applying King’s theory of goal attainment. The samples consist of 52 elderly with type 2 diabetes mellitus who had been identified as low or moderate risk of diabetic foot ulcer in a public health service center. The participants are equally divided into an experimental and a comparison group with 26 patients in each group. The duration of the intervention was 7 weeks. Data were collected at week 1, 5, and 7 by interviewed questionnaire that comprised of personal information, foot care knowledge, foot care behavior, and foot health assessment. Data were analyzed using descriptive statistic, chi-square test, Fisher's exact test, one-way repeated measure, independent t-test, and paired t-test. The research findings indicate that after receiving a diabetic foot prevention program, the experimental group had statistically significantly higher scores of knowledge and behaviors related to foot care for preventing diabetic foot at posttest and follow-up than pretest and those the comparison group (p-value<0.01). Additionally, the average foot health scores in the experimental group at follow-up were significantly higher than pretest and the comparison group (p-value<0.01). Therefore, the program applying King's goal attainment theory made the participants aware of their individual foot health issues. Setting goals and regularly evaluating progress provided continuous feedback for appropriate behavior. Along with increased knowledge and proper foot care behaviors, foot health problems can be improved.

Drowning Risk Among Children Aged 0-4 Years in Surin Province: Exploratory Research

Phimdara Meesuwan — 2024-12-19

Drowning is the leading cause of death among children aged 0-4 years due to unintentional injuries. This exploratory research aimed to investigate the risk of drowning in households with children aged 0-4 years in rural areas of Surin Province. The study, which took place in June 2024, included a total of 249 households. The researcher designed a drowning risk screening tool for children in this age group. The findings revealed that there were 305 children aged 0-4 years, with an average age of 2.1 years (S.D.=1.3), 53.1% of the children were female. Environmental risks indicated that 90.6% of households were located near water sources and lacked fences or barriers. The most common water sources inside the homes were basins (79.5%), followed by water tanks in bathrooms (74.3%) and buckets (73.5%). Outside the homes, the most common water sources were water jars (62.2%), followed by fish basins/lotus basins (22.9%), wells (22.1%), and paddling pools (19.3%). The study identified risk behaviors among primary caregivers that increased the likelihood of drowning incidents, included alcohol consumption (18.5%), a history of sedative medication use (1.6%), a history of abuse (1.2%), a history of harming others (0.8%) and a
history of limb weakness (0.4%). Additionally, personal risks included children with developmental delays (1.6%) and a history of epilepsy (0.3%). These findings underscore the various risk factors associated with drowning, including environmental factors, caregiver behaviors, and the children themselves. Therefore, it is crucial to implement planning and preventive measures to address these risk factors in order to reduce drowning incidents among children.

A survey on the tobacco industry's strategies at tobacco retail shops in Thailand

Sarunya Benjakul — 2024-12-19

This cross-sectional descriptive research examined tobacco industry’s strategies and supports aims at retailers that sell tobacco products and assessed awareness of tobacco product control laws among retail shops. A sample of retail shops selling tobacco products from 12 health regions and Bangkok was recruited through multi-stage random sampling, with a total of 1,360 retail shops. We collected data using an interview form and analyzed data using descriptive statistics. The research results revealed that tobacco industry strategies found in retail shops that sell tobacco products were as follows: place strategies, 5.7 percent having tobacco product packets clearly displayed for customers to see; promotional strategies, 2.3 percent advertising tobacco products including placing a label that shows the name or brand and the price in large letters; product strategy, 1.8 % had tobacco products that did not have labels or warning pictures as required by law; and price strategy, 3.4 percent selling tobacco products at a cheaper price than nearby stores. The most common type of support is a cabinet for displaying tobacco products, followed by labels or stickers of “This place sells cigarettes” and prizes when the specified amount is sold. For the awareness of the laws among retail shops, it was found that 88.5 percent were aware of the laws on tobacco products related to retail shops that sell tobacco products. However, some points were acknowledged in a small proportion with 39.3 percent. For example, sellers can request for identification card or other evidence of the buyer's age when a buyer is suspected to be under 20 years of age.

Quantity of fine particulate matter (PM 2.5) and assessment of respiratory health risks among individuals at a university in inner Bangkok

Montol Suwanprapha — 2024-12-19

This cross-sectional study aimed to investigate the concentration of particulate matter with a diameter of less than 2.5 microns (PM 2.5), associated health effects, the prevalence of abnormal respiratory symptoms, and the assessment of respiratory health risks among personnel at a university in the inner Bangkok zone. A Dust Sampler Mini Vol Air Sampler (AIR Metrics US) was employed to measure dust concentration, and tools were utilized to assess the risks and abnormal symptoms resulting from dust exposure. Purposive sampling was used to categorize the university personnel into six groups: students, lecturers, office staff, housekeepers, security guards, and convenience store employees, totaling 60 participants. The study found that the concentration of PM 2.5 in the university area, measured from January to March 2023, ranged from 8.0 to 72.0 µg/m3, with an average concentration of 29.21 µg/m3. The most commonly reported respiratory symptoms were nasal congestion and a runny nose, followed by eye and skin irritation, accounting for 51.70% and 31.70% of cases, respectively. The estimated health risk from dust exposure, indicated by the Hazard Quotient (HQ), ranged from 1.70 to 1.96, reflecting a level of risk that could affect health across all studies. The student group exhibited the highest risk ratio, followed by housekeepers, convenience store employees, security guards, office staff, and lecturers, with risk values of 1.96, 1.94, 1.92, 1.78, 1.78, and 1.70, respectively. These findings highlight the critical need for university personnel to maintain continuous awareness of the hazards associated with dust exposure and to strictly adhere to control and prevention measures to mitigate health risks and impacts.

Model of Transferring Missions for Prevention and Control of Diseases and Health Risks of Department of Disease Control to Local Administrative Organizations

Achara Bunchum — 2024-12-19

The Act on Decentralization Plans and Procedures for Local Government Organizations, B.E. 2542 (A.D.1999), assigns the Provincial Administrative Organizations (PAOs) to oversee the communicable disease prevention and control missions. This study aimed to evaluate the readiness of PAOs and examine the role of the Department of Disease Control (DDC), in order to propose a model for transferring the DDC’s missions on disease prevention and control to the Local Government Organizations (LGOs). The study covered 32 provinces, 86 executives were recruited to complete the questionnaires. Eight executives were subjected to the in-depth interview. The missions’ transferring model was referred to the 6 Building Blocks of a health system. The results revealed that 93% of respondents highlighted the necessity of redefining PAO roles in disease prevention and control, as well as health related threat management. The most critical areas requiring immediate attention were i) emerging communicable diseases such as COVID-19 (94.2%), ii) non-communicable diseases such as diabetes, hypertension, and cardiovascular diseases, and iii) occupational related diseases (80.2%). The overall readiness of PAOs to responsible for these missions was rated as moderate (x=2.24), where the aspect of leadership and governance were reported as well as the most readiness (x=2.65), followed by the financial aspect (x=2.51), and information and technology systems were found the least preparedness(x=1.86). In addition, the establishment of emergency operations centers (EOCs) mechanism at the sub-district level showed a low readiness score (x=1.79). Regarding the readiness of the disease prevention and control transferring missions, the executives’ opinions suggested that this depended on the leaders’ visions and reliance. In case of decentralisation, the local areas are able to self-manage and resolve the problems with support from DDC. DDC will focus on building up the capacity of local personnel so as to support LGOs. This transition should be accompanied by increased investment in developing robust management system of disease prevention, control, and health related threats, as well as information systems for effective emergency responses and outbreaks.