Rationale for Japanese encephalitis vaccination in short-term travellers to endemic areas

Although the Japanese encephalitis (JE) vaccine is typically strongly recommended for long-term high-risk travellers, some cases of JE infections have been reported amongst short-term travellers with seemingly low risk. This article underscores the advantages and reasoning behind JE vaccination for this particular group of travellers.

Recreational substance use among international travellers

BACKGROUND

Drug tourism reflects the expanding illicit drug market, posing health risks in unfamiliar travel settings. Existing knowledge specifically addressing substance use among international travellers is sparse and has not been reviewed to date. This review aimed to describe the recreational substance abuse in international travellers.

METHODS

A literature search was conducted on PubMed, Google Scholar, and Scopus using keywords related to recreational substances and international travellers. A total of 11 021 articles were reviewed, charted and summarized for the evidence on prevalence, patterns and characteristics of substance abuse and their health- and non-health-related problems on international travellers.

RESULTS

Fifty-eight articles were included. Most were cross-sectional studies and review articles. Twenty articles addressed the prevalence of substance abuse in travellers, 33 looked at characteristics and patterns of substance abuse in travellers and 39 investigated the health- and non-health-related problems from substance abuse. Estimated prevalence of recreational substances abuse varied from 0.7% to 55.0%. Rates of substances abuse were 9.45% to 34.5% for cannabis, 20.4% to 35.9% for alcohol intoxication, 2.82% to 40.5% for MDMA, 2% to 22.2% for cocaine, 2% to 15% for psychedelic agents and 2% for methamphetamine. The prevalence varied according to travellers' characteristics and travel destinations. Direct health problems included neuropsychiatric problems. Indirect problems included accident and unintentional injuries, crime and violence, risky sexual behaviours and sexual violence and blood-borne infections. Non-health-related problems included air rage, deportation and violation of local laws.

CONCLUSION

Substance abuse among international travellers is an underestimated problem that requires intervention. These findings emphasize the importance of addressing this issue to mitigate both health and well-being problems among travellers while promoting safer and more responsible travel experiences. In the context of travel health practices, practitioners should counsel travellers whose itineraries may include substance abuse, informing them about associated risks and consequences.

Diagnostic challenges and antibody kinetics in a paediatric traveller with scrub typhus

Diagnosing scrub typhus in travellers is challenging due to symptom similarities with other travel-related illnesses and limited early diagnostic tools. We present a distinctive case of scrub typhus in a child traveller, providing a comprehensive account of the case, the diagnostic challenges encountered, laboratory findings and the dynamics of antibodies.

The silent, rapidly unfolding threat of mpox spread via international travel to Southeast Asia: Are we ready?

The 2022 mpox (monkeypox) outbreak has been surprisingly large and has raised several novel questions about this disease. New information, such as atypical clinical manifestations and transmission via sexual activities, have been identified. These pose a potential risk of widespread outbreaks due to unusual clinical manifestations and failure to consider mpox as a diagnosis by physicians and the sexual behaviours of some tourists in Southeast Asia. Since Southeast Asia is a popular tourist destination, there is substantial potential for the silent spread of mpox in this region. Consequently, there is an urgent need for effective surveillance measures at points of entry of international travelers to identify suspected cases and their close contacts in order to limit the spread of mpox in Southeast Asia.

Heat-related illnesses are an increasing threat for travellers to hot climate destinations

The transition to El Niño during 2023 will result in a sharp rise in global heating, increasing the likelihood of breaking temperature records. Travellers are at increasing risk of heat-related illnesses (HRI) and should be prepared with advice about HRI prevention, recognition of early signs and first aid management.

Prevalence and associated risk factors of Leishmania infection among immunocompetent hosts, a community-based study in Chiang Rai, Thailand

Background

Leishmaniasis is an emerging infectious disease reported in the north and south of Thailand of which patients with HIV/AIDS are a high risk group for acquiring the infection. A lack of information regarding prevalence, and the risk association of Leishmania infection among asymptomatic immunocompetent hosts needs further investigation. Information on potential vectors and animal reservoirs in the affected areas is also important to control disease transmission.

Methods

An outbreak investigation and a cross-sectional study were conducted following one index case of cutaneous leishmaniasis (CL) caused by L. martiniquensis in an immunocompetent male patient reported in August 2015, Chiang Rai Province, Thailand. From September to November 2015, a total of 392 participants at two study areas who were related to the index case, 130 students at a semi-boarding vocational school and 262 hill tribe villagers in the patient’s hometown, were recruited in this study. The nested internal transcribed spacer 1-PCR (ITS1-PCR) was performed to detect Leishmania DNA in buffy coat, and nucleotide sequencing was used to identify species. Antibody screening in plasma was performed using the Direct Agglutination Test (DAT), and associated risk factors were analyzed using a standardized questionnaire. Captured sandflies within the study areas were identified and detected for Leishmania DNA using nested ITS1-PCR. Moreover, the animal reservoirs in the study areas were also explored for Leishmania infection.

Results

Of 392 participants, 28 (7.1%) were positive for Leishmania infection of which 1 (4.8%) was L. martiniquensis, 12 (57.1%) were L. orientalis and 8 (38.1%) were Leishmania spp. Of 28, 15 (53.6%) were DAT positive. None showed any symptoms of CL or visceral leishmaniasis. Risk factors were associated with being female (adjusted odds ratio, AOR 2.52, 95%CI 1.01–6.26), increasing age (AOR 1.05, 95%CI 1.02–1.08), having an animal enclosure in a housing area (AOR 3.04, 95%CI 1.13–8.22), being exposed to termite mounds (AOR 3.74, 95%CI 1.11–12.58) and having domestic animals in a housing area (AOR 7.11, 95%CI 2.08–24.37). At the semi-boarding vocational school, six Sergentomyia gemmea samples were PCR positive for DNA of L. orientalis and one S. gemmea was PCR positive for DNA of L. donovani/L. infantum. Additionally, one Phlebotomus stantoni was PCR positive for DNA of L. martiniquensis, and one black rat (Rattus rattus) was PCR positive for DNA of L. martiniquensis.

Conclusion

This information could be useful for monitoring Leishmania infection among immunocompetent hosts in affected areas and also setting up strategies for prevention and control. A follow-up study of asymptomatic individuals with seropositive results as well as those with positive PCR results is recommended.

This is the first community-based study investigating the prevalence and associated risk factors of Leishmania infection among immunocompetent individuals, demonstrating the situation of Leishmania infection in endemic areas of Thailand. An outbreak investigation and a cross-sectional study were conducted following one index case of cutaneous leishmaniasis (CL) caused by L. martiniquensis in an immunocompetent male patient reported in August 2015, Chiang Rai Province, Thailand. Of 392 participants, 28 (7.1%) were positive for Leishmania infection of which 1 (4.8%) was L. martiniquensis, 12 (57.1%) were L. orientalis and 8 (38.1%) were Leishmania spp. The factors associated with Leishmania infection included being female, increasing age, having an animal enclosure in a housing area, being exposed to termite mounds and having domestic animals in a housing area. This information revealed the first burden and risk factors of Leishmania infection among immunocompetent individuals in Thailand and highlighted the urgent need for effective interventions to prevent and control the disease in high risk populations in endemic areas.

Six-year trend and risk factors of unsuccessful pulmonary tuberculosis treatment outcomes in Thai Community Hospital

OBJECTIVE

Tuberculosis (TB) is a major cause of morbidity and mortality globally. Despite efforts to eliminate TB in Thailand, the incidence rate has declined slowly. This study aimed to identify the incidence and risk factors of unsuccessful pulmonary TB treatment (failed, died and loss-to- follow up) in a community hospital in Chachoengsao Province, Thailand from 1st January 2013 to 31st December 2019.

RESULTS

A total of 487 patients were eligible for the study. The incidence of unsuccessful treatment was 21.67/100 population person year. Risk factors of unsuccessful pulmonary TB treatment were unemployment (adjusted hazard ratio (AHR) 3.12, 95%CI 1.41-6.86), HIV co-infection (AHR 2.85, 95%CI 1.25-6.46), previous history of TB (AHR 2.00, 95%CI 1.04-3.81), positive sputum AFB at the end of the intensive phase (AHR 5.66, 95%CI 2.33-13.74), and sputum AFB was not performed at the end of the intensive phase (AHR 18.40, 95%CI 9.85-34.35). This study can be utilized to improve prevention and intervention of TB treatment by strengthening public health system on treatment quality especially TB patient monitoring tools or methods easy for accessing to patients in communities.

Risk Factors of Leishmania Infection among HIV-Infected Patients in Trang Province, Southern Thailand: A Study on Three Prevalent Species

There are two main species of Leishmania reported in Thailand, that is, Leishmania siamensis and Leishmania martiniquensis. Moreover, leishmaniasis cases caused by Leishmania donovani complex were also reported. There is still a lack of information concerning risk factors of Leishmania infection in Thailand. This study aimed to identify the risk factors of Leishmania infection caused by these three species among HIV-infected patients. A cross-sectional study was conducted in HIV clinic at Trang Hospital, Thailand. Nested PCR and sequencing were performed to detect Leishmania DNA in blood and saliva samples and identify Leishmania species. A standardized questionnaire was used to interview individuals. A total of 526 patients were recruited in this study. Sixty-three (12.0%) were positive for L. siamensis, 24 (4.6%) were positive for L. martiniquensis, and 23 (4.4%) were positive for L. donovani complex. Risk factors of L. siamensis infection included using intravenous drug (adjusted odds ratio [AOR] 2.01, 95% CI: 1.01-4.02). Risk factors of L. martiniquensis infection included female gender (AOR 4.23, 95% CI: 1.52-11.75), using recreational drug (AOR 3.43, 95% CI: 1.00-11.74), and having comorbidities (AOR 4.94, 95% CI: 2.00-12.21). Risk factors of L. donovani complex infection included having opportunistic infection (AOR 4.22, 95% CI: 1.00-17.79), CD4 count 200-500 cells/mm³ (AOR 3.64, 95% CI: 1.14-6.86), and not using insect repellent (AOR 3.04, 95% CI: 1.08-8.58). This study identified the risk factors of Leishmania infection caused by three Leishmania species in Thailand. The data could be useful for disease prevention and control. Further studies on trends of Leishmania infection and preventive measures are recommended.

Effectiveness of influenza vaccine among health care personnel in Thailand, 2018/19 season

Background

Influenza vaccination is the most effective way of preventing influenza infections and it is recommended for the entire health care personnel in Thailand. However, the evidence of influenza vaccine effectiveness (VE) among health care personnel is lacking in Thailand. The objective of this study was to estimate influenza vaccine effectiveness (VE) against laboratory confirmed medically attended influenza illness for the 2018/9 season among health care personnel who at risk for influenza infection in Bangkok, the capital of Thailand.

Methods

Throat swab specimens were collected from patients with influenza-like illness (ILI) presenting to outpatient clinics and tested for influenza virus by RT-PCR, between October 2018 and September 2019. A test-negative case-control design was used to estimate influenza VE against medically-attended laboratory-confirmed influenza in outpatient settings. Cases were influenza-like illness (ILI) patients who tested positive for influenza, and controls were influenza negative patients.

Results

During the 2018/19 season 373 samples were collected; 57 (15.3%) were positive for influenza, 70.2% A un-subtyped and 29.8% B. Adjusted VE against all influenza viruses for this influenza season was -31.7% (95% confidence interval (CI): -40.2 to 66.4), against influenza A un-subtyped, it was 43.9% (95% CI: -30.6 to 75.9) and against influenza B, it was 52.0% (95% CI: (-73.9 to 86.8).

Conclusions

The seasonal influenza vaccine was moderately effective against medically attended lab-confirmed influenza infection in health care personnel in Bangkok, Thailand in the 2018-19 influenza season.

Key messages

The seasonal influenza vaccine was moderately effective against medically attended lab-confirmed influenza infection in health care personnel in Bangkok. Increasing seasonal influenza vaccination among health care personnel in Thailand may decrease medically attended influenza-associated ILI cases in this population.

Epidemiology of influenza: findings from surveillance system of 40 hospital in Thailand, 2010-2019

Background

Although recent efforts from some Asian countries to describe burden of influenza disease and seasonality, these data are missing for the vast majority, including the private section of Thailand. A near real-time laboratory-based influenza surveillance system, in a network of 40 hospitals was implemented aiming to determine influenza strains circulating in the private hospitals of Thailand and know characteristics, trend and burden of influenza viruses.

Methods

We obtained the data by monitoring patients with influenza-like illness (ILI) at a network of 40 private hospitals across Thailand. Throat-swab specimens in viral transport media were collected and transported within 24 h of collection using a cold-chain system. The respiratory samples were tested by rapid influenza diagnostic tests and real-time reverse transcription polymerase chain reaction.

Results

From January 2010 to November 2019, a total of 1,300,594 subjects were tested and 320,499 cases of influenza were identified. Of those positive cases, 116,317(36.3%) were influenza type B, 185,512(57.9%) were influenza A unspecified subtype, 8,833(2.7%) were influenza A(H1N1)pdm2009 and 6,371(1.9%) were seasonal influenza A(H3N2). Positive rate were 50.5 and 49.5 in female and male. Positivity rate was 41.4% in persons 15-49 years followed by 29.1% in 15-14 years, 17.6% in under five children and 11.7% in > 49 years. In 2018-2019 season, the highest positivity rate observed in February and March (39.3%) followed by April (34.2%) and January (32.3%) while the lowest positivity rate was in May (18.1%).

Conclusions

In Thailand, seasonal Influenza A(H3N2), Influenza A(H1N1)pdm2009 and Influenza B viruses were circulating during 2010-2019. In last season, positivity rate and number of cases peaked in February and March.

Key messages

Influenza is one of public health problems in Thailand. The need to introduce influenza vaccine and antivirus is important to prevent and treat the disease in future.

Characteristics of Poor Tuberculosis Treatment Outcomes among Patients with Pulmonary Tuberculosis in Community Hospitals of Thailand

Pulmonary tuberculosis (TB) is a major global public health problem. Thailand is listed as one of the countries with a high burden of pulmonary TB. Various factors are known to contribute to unsuccessful pulmonary TB treatment. However, studies in Thailand remain limited, especially in rural settings. This study aimed to identify the prevalence and associated factors of unsuccessful pulmonary TB treatment in community hospitals. A cross-sectional study was conducted from June-July 2019. We enrolled all patients receiving treatments in four community hospitals in central Thailand. The collected data included baseline characteristics, comorbid illnesses, a history of directly observed treatment-short course (DOTS), sputum acid-fast bacilli smear results, and chest radiography and treatment outcomes. Univariate and multivariate analyses were used to identify factors associated with unsuccessful pulmonary TB treatment. A total of 786 patients were enrolled in the study. Prevalence of unsuccessful treatment was 18.7%. Associated factors of unsuccessful pulmonary TB treatment were previously treated TB (adjusted odds ratio [AOR]: 2.1, 95% CI: 1.2-3.7), existence of comorbid illnesses (AOR: 2.8, 95% CI: 1.5-5.0), DOTS not performed (AOR: 2.5, 95% CI: 1.4-4.5), chest radiography showing multiple lung lesions at first diagnosis (AOR: 3.0, 95% CI: 1.7-5.2), no chest radiography improvement in the first follow-up (AOR: 17.7, 95% CI: 8.2-38.0), and unknown status of chest radiography in the first follow-up (AOR: 48.1, 95% CI: 22.3-103.5). Health promotion and primary care should be implemented in the communities to achieve ultimate successful treatment.

Prevalence and associated factors influencing depression in older adults living in rural Thailand: A cross-sectional study

AIM

Depression is a major disease burden in Thailand. In rural areas, young adults will leave home to work in cities, and older adults are left behind. Loneliness and comorbidities can lead to depression in older adults. The present study aimed to evaluate the prevalence and associated factors for geriatric depression.

METHODS

A cross-sectional study was carried out. Questionnaires including the Thai Geriatric Depression Scale and family relationship were obtained by healthcare professions by face-to-face interviews of 584 older people aged ≥60 years in Ban Nayao community, Chachoengsao Province, Thailand. Geriatric depression can be defined as depressive syndromes that arise in adults aged ≥60 years. We excluded those who had visual or auditory disabilities or did not pass the Thai Mini-Mental Status Examination. The prevalence and associated factors for geriatric depression were obtained. Associated factors were analyzed by multivariate logistic regression.

RESULTS

A total of 433 older people were eligible. The prevalence of geriatric depression was 18.5%. Of the participants, 54.1% lived in an imbalanced family type. Multivariate analysis showed the significance for female sex (adjusted OR 2.78, 95% CI 1.54-7.49, P = 0.01), illiteracy (adjusted OR 2.86, 95% CI 1.19-6.17, P-value 0.04), current smoker (adjusted OR 4.25, 95% CI 2.12-10.18, P = 0.009) and imbalanced family type (low attachment, low cooperation and poor alignment between each member; adjusted OR 4.52, 95% CI 2.14-7.86, P < 0.001) as risk factors for depression.

CONCLUSIONS

The prevalence of geriatric depression in rural Thailand is high. Imbalanced family type is an important risk factor for geriatric depression in the rural community. Geriatr Gerontol Int 2019; 19: 1248-1253.

Factors Influencing Problem-Based Learning: Students’ and Teachers’ Perspectives

This article was migrated. The article was not marked as recommended. Aim : Problem-based learning(PBL) is a widely accepted teaching and learningmethod being used in most accredited medical schools. Phramongkutklao College of Medicine routinely utilized this powerful method. This paper involves the use of problem-based learning in teaching malaria sessionduring parasitology course. From our experience, there is a number of contributing factor to the success of PBL.The objective of this study is to critically explore students and teachers' perspectives on factors influencing PBL at our institution. Methods : A cross-sectional study was performed on 204 medical students and 25 medical educators. Demographic data and perceptions toward PBL were obtained using electronic standardized questionnaire in 5 score rating scale. The questions were divided into 6 categories: objective and content, stress and anxiety, teachers' role, group work attitude, self-preparation and self-assessment. Independent T-test was used to compare means between students' and teachers' perspectives. Exploratory factor analysis (EFA) was used to explore loading factor of each factor. Results : The Cronbach's alpha revealed that the questionnaire was generally reliable (0.78). Objective and content (p-value 0.003), students' preparation (p-value 0.005) and student assessment (p-value 0.026) had significantly different view between students and teachers while the other topics shared parallel view by both groups. In addition, student assessment (λ = 0.84), student's preparation (λ = 0.83) and attitudes in group work (λ = 0.82) have high impact over PBL. Conclusions : It can be concluded that, both students and teachers had generally good attitude toward PBL. We concluded that good attitude and preparation in problem-based learning session from both students and teachers are vital to good quality and successfulness in implementation of problem-based learning.

What Learning Resource Persons do Clinical Medical Students Prefer?

This article was migrated. The article was marked as recommended. Introduction Nowadays, clinical medical students need to find suitable learning resource persons to cope with knowledge and develop their skills. Resource persons include faculties, residents, peers or each individual medical students' self-study. The aim of this study was to compare the differences perspectives and give feedback to stakeholders for learning achievements. Methods 142 medical students answer 5-rating scale questionnaire including 6 aspects; knowledge acquired, accuracy of information, clinical skills, active learning stimulation, comfortable learning environment and time consuming which each had 4 question. Statistical analysis was compared outcomes between groups of resource person by using one-way ANOVA and exploratory factor analysis (EFA). Results Simulation of active learning was greatly impacted by faculties (component matrix 0.793) with self-study in the second place (component matrix 0.781). Peers got least impact in acquiring knowledge (component matrix 0.707) but was greatly impacted on clinical skill (component matrix 0.717). Self-study had least impact on clinical skill (component matrix 0.521). Learning with residents and self-study had greatest impact on comfortable learning environment (component matrix 0.813, 0.809 respectively). Peers had highest impact as the learning resource who consumed least time in learning (component matrix 0.858) and accuracy of information (component matrix 0.784). Faculties had lowest impact on accuracy of information (component matrix 0.506). There were significant different average student perspective scores from multiple resources learning (p-value 0.01). In general, students mostly favored learning with residents while faculties got second place; however, there was insignificant differences between peers and self-study. Conclusion Residents were the most favored learning resource because they had more experiences and knowledge than peers and had small age gap with students, thus students felt more comfortable to discuss. In addition, faculties, peers and self-study were important as they could still stimulate medical students to develop other important skills (communication skill, clinical skill and stress management).