Epidemiology, clinical presentations and burden of rotavirus diarrhea in children under five seen at Ramathibodi Hospital, Thailand.

BACKGROUND: To be able to monitor the impact of rotavirus vaccines in the future, the authors designed the present study along with the Rotavirus Surveillance Project-Thailand. OBJECTIVE: To examine the epidemiology, clinical presentation, and direct medical cost of rotavirus-caused diarrhea in Thailand MATERIAL AND METHOD: Clinical presentations of all diarrhea cases during the study period were analyzed Rotavirus diarrhea was confirmed with polyacrylamide gel electrophoresis. Serological typing was characterized by reverse transcription-polymerase chain reaction. RESULTS: Between April 2001 and March 2002, 239 under 5-year-old diarrhea cases admitted in Ramathibodi Hospital, Thailand were identified Clinical presentations and laboratory results were analyzed from 85 cases. Rotavirus was identified in 48.2% of the specimens. The most common serotypes were G9 (67%), G4 (23%), and GI (2%) respectively. The most common age of rotavirus diarrhea was 12-17 months. The seasonal peak was during November 2001 to January 2002 (the cool and dry season in Thailand). The predominant symptoms were watery diarrhea, fever, and vomiting. Rotavirus diarrhea tended to have more dehydration and metabolic acidosis than other causes. The G4 serotype was associated with the most severe presentations. CONCLUSION: The proportion of rotavirus diarrhea in the present study was 48%. The mean direct medical cost per episode of rotavirus diarrhea per child was 2,101 baht (approximately 52 US $).

A food borne outbreak of gastroenteritis due to shigella and possibly salmonella in a school.

On August 5, 2005, a private hospital reported a large number of students with gastrointestinal illness from the same school in Bangkok, Thailand. The Bureau of Epidemiology along with the Bangkok Metropolitan Administration investigated this outbreak, to determine risk factors, identify the source of infection and possible causative organism, and recommend prevention and control strategies. A case was defined as a person who was studying or working at School A and who developed abdominal pain, diarrhea, nausea or vomiting during the five-day period of August 4 to 8, 2005. A descriptive study was carried out for active case-finding, medical records review, and case interviews. We conducted the retrospective cohort study among third and fourth grade students. Stool samples were collected and tested at the Thai National Institute of Health and at private hospital laboratories. The overall attack rate was 37%. Main symptoms were diarrhea, fever, headache, abdominal pain, vomiting, and nausea. The highest attack rate (63%) was among fourth-grade students. Based on food-history data collected from ill and well students, a multiple logistic regression analysis showed that a mixed chicken and rice dish served for lunch on August 4 was associated with illness (OR 3.28, 95% CI 1.46-7.36). Among stools samples from 103 cases, Shigella group D was found in 18 cases, Salmonella group C in 5 cases, and Salmonella group E in 2 cases. This food borne outbreak of gastroenteritis was most likely caused by Shigella spp although the possibility of mixed contamination with Shigella and Salmonella spp cannot be ruled out. Food borne outbreaks such as this can be prevented through simple and effective hygienic measures.

Leptospirosis in Takeo Province, Kingdom of Cambodia, 2003.

BACKGROUND: In Cambodia, epidemiology and disease burden of leptospirosis were not addressed as they do not have an existing surveillance system and have limitations on their laboratory diagnosis. OBJECTIVE: Define the existence of leptospirosis and determine the antibodies to serovars of leptospires in Cambodia. MATERIAL AND METHOD: One hundred and twenty-one suspected cases of leptospirosis were enrolled in this cross-sectional study, between September 8 and November 30, 2003 from Takeo Provincial Hospital in Doun Keo District, Cambodia. RESULTS: Common clinical manifestations were fever (96%), headache (92%), and myalgia (87%). Common risk behaviors were throwing garbage on the ground (84%), pulling out sprouts (77%), fertilizing (49%), and plowing (47%). Microscopic agglutination test result confirmed four cases and polymerase chain reaction test result confirmed seven cases. Two cases each showed antibodies to serovars Javanica and Australis. An estimated annual incidence of leptospirosis in Takeo province was 7.65 per 100,000 populations. Further studies to define epidemiology and burden of disease are needed. CONCLUSION: Increasing awareness and knowledge on leptospirosis among people are necessary to decrease the impact of leptospirosis in Cambodia.