Surveillance of neonatal tetanus in Thailand, 1977-1986.

Information on the morbidity and mortality of neonatal tetanus was reviewed to evaluate the impact of the immunization programme among pregnant women in Thailand from 1977. We also analysed the epidemiological characteristics of investigated neonatal tetanus cases during the period 1984-1986. The neonatal tetanus case rate declined from 72.1 per 100,000 livebirths in 1977 to 53.7 per 100,000 livebirths in 1986. Reduction in the incidence rate was inversely associated with increasing vaccination coverage of pregnant women with tetanus toxoid. The ratio of male to female neonatal tetanus was 1.5 to 1. Approximately 95 per cent of the cases occurred within the first 14 days of life, with the highest number recorded at 6-8 days of life. The majority of investigated cases were infants who became ill following delivery assisted by traditional birth attendants or relatives of mothers. About 88 per cent of these cases were infants whose mothers had no tetanus immunization. Razor blades and bamboo splits were the most frequently used instruments for cutting the umbilical cord. Strategies to control neonatal tetanus in Thailand should include immunization of pregnant women with tetanus toxoid, and more comprehensive training and supervision of untrained birth attendants.

Foodborne disease outbreaks of chemical etiology in Thailand, 1981-1987.

A study was conducted to determine the current situation of chemical foodborne outbreaks in Thailand for the period 1981-1987. Seventy-three outbreaks of chemical poisoning involving 1236 persons of whom 54 died were reported. Twenty outbreaks affecting 722 cases were caused by insecticide poisoning and methomyl was the most commonly recognized insecticide involved. Poisonous plants were responsible for 43 outbreaks with 420 cases. Mushroom poisoning was the most common entity (21 outbreaks, 211 cases), with plant seed poisoning next (9 outbreaks, 179 cases). There were 8 outbreaks following consumption of poisonous seafoods. Mussels were identified to be the vector in the outbreak of PSP. Horseshoe crabs which served as the vehicles for 4 outbreaks were also suspected to be associated with PSP. Puffer fish accounted for the remaining 3 outbreaks involving 6 cases of tetradotoxin poisoning. More complete reporting and more effort in outbreak investigations are needed for appropriate preventive and control measures.

Epidemiology of human rabies post-exposure prophylaxis in Bangkok, 1984-1986.

A study was conducted to determine the current situation of human rabies post-exposure prophylaxis (PEP) in Bangkok for the period 1984-1986. A review of all Bangkok residents receiving PEP at the Queen Saovabha Memorial Institute revealed an increasing incidence rate of PEP from 10.1 cases per 10,000 persons in 1984 to 12.6 cases per 10,000 persons in 1986. The highest incidence rate was observed in young males aged 5-14 years. About 68% of individuals receiving PEP had exposures to bites, especially by dogs, and nearly 30% of PEP cases were due to non-bite exposures. Dogs were responsible for 90% of PEP cases, of which 59% were exposed to stray dogs. Exposure to domestic dogs and cats constituted about 36% of PEP. Approximately 55% of persons received PEP for exposures to animal sources not proven rabid. To reduce the number of PEP, the programme should be directed towards the swift reduction of susceptible animals, which can be achieved by effective elimination of stray dogs and immunization of domestic dogs and cats. Massive health education to the public emphasizing the importance of prevention and control of rabies should be undertaken. The programme for control of rabies can be effective if there is an increased awareness and cooperation among professional people, health personnel, and other people in the community.