ABSTRACT
In Thailand, rabies remains an important zoonotic disease due to its lethality in humans. Although the numbers of human rabies cases have been steadily decreasing over the past ten years, the epidemiological situation has started to change. Assessment of human rabies was based on the national infectious disease surveillance system from B.E. 2546-2550. There were 106 cumulative cases distributed in all four regions of Thailand. The highest mortality rates were found in the Central and Southern regions. Dogs were the main reservoir with the highest percentage found in puppies younger than 3 months (45%). Most of the causal dogs, and 61% of the dogs with owners had not received Rabies vaccination each year. The data strongly revealed that most of the human rabies cases did not receive rabies vaccine after the animal contact or bite. Prevention and control strategies should focus especially on the regions and provinces which had the highest number of cases, or on those regions which continue to have incident cases each year. It is also essential to set up a better control of the animal population which can potentially infect humans.
ABSTRACT
Pneumonia remains a leading public health concern in Thailand. Using population-based surveillance during January 2004-December 2006, we describe incidence, mortality, and bacterial etiologies of chest radiograph-confirmed pneumonia requiring hospitalization in one rural Thai province. Of 19,316 patients who met the case definition for clinical pneumonia, 9,596 (50%) had a chest radiograph, and 4,993 (52%) of those had radiographically-confirmed pneumonia. The incidence of radiographically-confirmed pneumonia ranged from 199 to 256 per 100,000 persons per year; 151 (3.0%) patients died. The annual average pneumonia mortality rate was 6.9 per 100,000 persons (range 6.2 to 7.8 per 100,000) and was highest in persons aged < 1 year (64/100,000) and > or = 65 years (44/100,000). Of 4,993 patients with radiographically-confirmed pneumonia, 1,916 (38%) had blood cultures, and 187 (10%) of those had pathogens isolated. Pathogens causing bacteremic pneumonia included B. pseudomallei (15% to 24% of bacterial pathogens), E. coli (9.2% to 25%), S. pneumoniae (7.9% to 17%), K. pneumoniae (2.2% to 6.4%), and S. aureus (4.3 to 5.3%). Bacteremia was significantly associated with pneumonia mortality after controlling for age, sex, HIV status and measures of disease severity in a logistic regression model (OR=5.2; 95% confidence interval= 2.2-12). Pneumonia remains an important cause of morbidity and mortality in Thailand, as in other countries in Southeast Asia. These findings can inform pneumonia clinical management and treatment decisions and guide public health programming, including the development of effective prevention strategies.