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. 2019 Nov 19;6(12):ofz498.
doi: 10.1093/ofid/ofz498. eCollection 2019 Dec.

Clinical Epidemiology of 7126 Melioidosis Patients in Thailand and the Implications for a National Notifiable Diseases Surveillance System

Viriya Hantrakun  1 , Somkid Kongyu  2 , Preeyarach Klaytong  1 , Sittikorn Rongsumlee  1 , Nicholas P J Day  1   3 , Sharon J Peacock  4 , Soawapak Hinjoy  2   5 , Direk Limmathurotsakul  1   3   6
Affiliations

Clinical Epidemiology of 7126 Melioidosis Patients in Thailand and the Implications for a National Notifiable Diseases Surveillance System

Viriya Hantrakun et al. Open Forum Infect Dis. .

Abstract

Background: National notifiable diseases surveillance system (NNDSS) data in developing countries are usually incomplete, yet the total number of fatal cases reported is commonly used in national priority-setting. Melioidosis, an infectious disease caused by Burkholderia pseudomallei, is largely underrecognized by policy-makers due to the underreporting of fatal cases via the NNDSS.

Methods: Collaborating with the Epidemiology Division (ED), Ministry of Public Health (MoPH), we conducted a retrospective study to determine the incidence and mortality of melioidosis cases already identified by clinical microbiology laboratories nationwide. A case of melioidosis was defined as a patient with any clinical specimen culture positive for B. pseudomallei. Routinely available microbiology and hospital databases of secondary care and tertiary care hospitals, the national death registry, and NNDSS data were obtained for analysis.

Results: A total of 7126 culture-confirmed melioidosis patients were identified from 2012 to 2015 in 60 hospitals countrywide. The total number of cases diagnosed in Northeast, Central, South, East, North, and West Thailand were 5475, 536, 374, 364, 358, and 19 cases, respectively. The overall 30-day mortality was 39% (2805/7126). Only 126 (4%) deaths were reported to the NNDSS. Age, presentation with bacteremia and pneumonia, prevalence of diabetes, and 30-day mortality differed by geographical region (all P < .001). The ED at MoPH has agreed to include the findings of our study in the next annual report of the NNDSS.

Conclusions: Melioidosis is an important cause of death in Thailand nationwide, and its clinical epidemiology may be different by region. In developing countries, NNDSS data can be supplemented by integrating information from readily available routine data sets.

Keywords: Burkholderia pseudomallei; epidemiology; melioidosis; notifiable diseases; surveillance system.

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Figures

Figure 1.
Figure 1.
Flowchart of the study. aIn 2012, there were 68 public general hospitals (acting as secondary care hospitals) and 28 public regional hospitals (acting as tertiary care hospitals) in Thailand [24].
Figure 2.
Figure 2.
Incidence rates of culture-confirmed melioidosis in Thailand from 2012 to 2015. Provinces are categorized based on incidence rates of culture-confirmed melioidosis observed (dark red, >5 cases per 100 000 population per year; red, >1–5 cases per 100 000 population per year; yellow, >0–1 cases per 100 000 population per year; green, no cases observed; and gray, no data)
See this image and copyright information in PMC

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