Enhanced surveillance for severe pneumonia, Thailand 2010\u20132015

Charatdao Bunthi,Thitipong Yingyong,Henry C Baggett,Malinee Chittaganpitch,Christopher J Gregory,Somsak Thamthitiwat,Pasakorn Akarasewi,Wantana Paveenkittiporn,Anusak Kerdsin,Kumnuan Ungchusak,Ruchira Ruangchira-Urai

doi:10.1186/s12889-019-6774-5

Abstract

BackgroundThe etiology of severe pneumonia is frequently not identified by routine disease surveillance in Thailand. Since 2010, the Thailand Ministry of Public Health (MOPH) and US CDC have conducted surveillance to detect known and new etiologies of severe pneumonia.MethodsSurveillance for severe community-acquired pneumonia was initiated in December 2010 among 30 hospitals in 17 provinces covering all regions of Thailand. Interlinked clinical, laboratory, pathological and epidemiological components of the network were created with specialized guidelines for each to aid case investigation and notification. Severe pneumonia was defined as chest-radiograph confirmed pneumonia of unknown etiology in a patient hospitalized ≤48 h and requiring intubation with ventilator support or who died within 48 h after hospitalization; patients with underlying chronic pulmonary or neurological disease were excluded. Respiratory and pathological specimens were tested by reverse transcription polymerase chain reaction for nine viruses, including Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and 14 bacteria. Cases were reported via a secure web-based system.ResultsOf specimens from 972 cases available for testing during December 2010 through December 2015, 589 (60.6%) had a potential etiology identified; 399 (67.8%) were from children aged < 5 years. At least one viral agent was detected in 394 (40.5%) cases, with the most common of single vial pathogen detected being respiratory syncytial virus (RSV) (110/589, 18.7%) especially in children under 5 years. Bacterial pathogens were detected in 341 cases of which 67 cases had apparent mixed infections. The system added MERS-CoV testing in September 2012 as part of Thailand’s outbreak preparedness; no cases were identified from the 767 samples tested.ConclusionsEnhanced surveillance improved the understanding of the etiology of severe pneumonia cases and improved the MOPH’s preparedness and response capacity for emerging respiratory pathogens in Thailand thereby enhanced global health security. Guidelines for investigation of severe pneumonia from this project were incorporated into surveillance and research activities within Thailand and shared for adaption by other countries.

Highlights

The etiology of severe pneumonia is frequently not identified by routine disease surveillance in Thailand
The majority (61.7%) were children aged < 5 years and the largest proportion (35.1%) of cases came from the southern region of Thailand
Blood cultures were done at the participating hospitals per their routine practice and only 337 patients (34.7%) had results available

Summary

Introduction

The etiology of severe pneumonia is frequently not identified by routine disease surveillance in Thailand. In 2003 and 2004, the World Health Organization reported that the avian influenza A H5N1 virus had spread from Asia to Europe and Africa, resulting in millions of poultry infections, 50 human cases, and 36 human deaths [7, 8] These avian influenza outbreaks have had serious impact on national economies and international trade. Due to limited resources, the NAIS did not conduct diagnostic testing for other pathogens in severe pneumonia cases that tested negative for influenza To expand this influenza-specific system, an enhanced surveillance system for severe and fatal pneumonia (SevPn) was established by the Bureau of Epidemiology (BOE) and National Institute of Health (NIH), Thailand MOPH, in collaboration with the United States Centers for Disease Control and Prevention (US CDC)

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