Beriberi outbreak among commercial fishermen, Thailand 2005.

In April 2005, The Tahi Bureau of Epidemiology investigated a reported outbreak of beriberi among commercial fishermen in Maha Chai, a port city in the Gulf of Thailand. The objective of this study was to verify the diagnosis of beriberi in affected individuals, describe the possible outbreak, ascertain risk factors, and provide prevention and control measures. We interviewed ill persons and treating doctors, and reviewed medical records to conduct a descriptive study. A probable case was defined as a crewmember of Ship A with one of the following: leg edema scrotal edema or ascites, dyspnea, chest discomfort, chest pain, extremity numbness, or extremity weakness. Confirmed cases were those with clinical criteria and laboratory findings consistent with thiamine deficiency. The outbreak started in early March, 2005 and continued until March 31, 2005. Ship A had 28 crewmembers (four Thai, 24 Myanmar). Overall, there were 15 probable cases (attack rate 53.6%, with three confirmed and 12 probable cases). Only three were tested for Vitamin B1 deficiency. All cases were male, with a median age of 28 years (range 20-45). Fourteen of the 15 cases were Myanmar and one Thai. Due to limited resources, the crew ate only seafood and polished rice for almost two months prior to symptoms. Symptoms included edema (60%), chest discomfort (54%), and dyspnea (27%). Two persons died while on board the ship (case fatality 13%). The total time at sea for Ship A was 18 months, including a five-month delay in docking due to licensing problems.

A common-source water-borne outbreak of multidrug-resistant typhoid fever in a rural Thai community.

We report an epidemiological investigation of an explosive water-borne outbreak caused by multidrug-resistant (MDR) Salmonella Typhi in a non-endemic community with otherwise good sanitation. Between 31 October and 11 November 1999, 11 cases of typhoid fever occurred in Poppra District, Tak Province. Four cases were children < or = 14 years of age and the remaining 7 were adults 15-24 years old. Hemoculture was performed in 10 of the 11 cases, of whom 5 (50.0%) were positive for Salmonella Typhi. All the isolates were of Vi phage type E14 which was resistant to chloramphenicol, ampicillin, co-trimoxazole, tetracycline, and streptomycin but sensitive to kanamycin, ofloxacin, ciprofloxacin, and cefotaxime. One confirmed case developed intestinal perforation leading to death. A case-control study revealed a significant association between disease and drinking unboiled spring water. The implication of spring water was supported by the presence of faecal contamination in the spring water source. Rapid identification of the possible transmission source and prompt implementation of control measures curtailed the spread of this outbreak.