Date: Sun 19 May 2019
Source: Nation Multimedia [edited]
<http://www.nationmultimedia.com/detail/breakingnews/30369655>

As many as 249 babies were born with syphilis in Thailand this year [2019], according to the Public Health Ministry. "The babies were affected because their mothers were infected," the ministry's permanent secretary, Dr Sukhum Karnchanapimai, said yesterday [18 May 2019].

Sukhum said that between 1 Jan and 13 May 2019, 3080 people of all ages were diagnosed with syphilis. Of them, 40.42 per cent are between 15 and 24 years old. Some 24.48 per cent of others are between 25 and 34 years old. "The number of syphilis patients is rising. The increase reflects that many teenagers and people in the reproductive age group have engaged in unsafe sex," he said.

Sukhum said he has instructed provincial public-health chiefs to closely monitor the situation and to prevent the disease from spreading. He urged people to protect themselves by using condoms, refraining from having several sex partners, and regularly undergoing blood tests. "Pregnant women, along with their husbands, should take blood tests too," he said.
=====================
[Thailand was said to have eliminated congenital syphilis by the WHO just a few years ago (2016) (See Sidibe M, Singh PK below.) Thailand thus joins the countries that now report a rise in incidence of congenital syphilis. In the U.S., for example, after syphilis reached historic lows in 2000, with less than 6000 reported cases and an incidence rate of only 2.1 cases per 100 000 people, the United States has since experienced a rising incidence of primary and secondary (P&S) syphilis (<https://www.cdc.gov/std/sam/2017syphilis.htm>). Initially, during 2000-2015, the rise in the rate of reported P&S syphilis in the US was primarily attributable to increased cases among men, specifically among gay, bisexual, and other men who have sex with men (MSM). More recently, syphilis also increased among women. For example, during 2014-2015, the rate increased 18.1 percent among men, but increased 27.3 percent among women  (<http://www.loopcayman.com/content/syphilis-cases-increase-1>).

These increases among women are of particular concern because congenital syphilis cases tend to increase as the rates of primary and secondary syphilis increase among women  (<https://www.cdc.gov/std/stats16/figures/44.htm>).

Transmission of _Treponema pallidum_, the organism that causes of syphilis, to the fetus occurs via the bloodstream when the foetus is exposed in utero to a mother with untreated early syphilis. Transmission may also occur during delivery if maternal genital lesions are present. Late abortion, stillbirth, and neonatal death may result from congenital infection in untreated pregnancies. Among survivors, manifestations that develop in the 1st 2 years of life are called "early" and are similar to adult secondary syphilis; manifestations that develop after age 2 years are called "late" and include tooth abnormalities (Hutchinson teeth), bone changes (saber shins), "Clutton's joints" (bilateral painless swelling of the knee joints), neurological involvement, blindness, and deafness.

We are not told in the news report above about the factors responsible for the changing epidemiology of syphilis in Thailand, which could account for their increasing incidence of congenital syphilis. In the U.S. and Canada, the recent increasing incidence of syphilis in heterosexual men and women has been linked to illicit drug use, which is reminiscent of the increase in syphilis among heterosexuals during the crack cocaine epidemic of the 1980s and 1990s, when the practice of trading sex with multiple partners for drugs, especially crack cocaine, played a major role in the transmission of syphilis. Under these circumstances, the identities of sex partners are often unknown, which weakens the traditional syphilis-control strategy of partner notification.

Control of congenital syphilis is achieved by antenatal screening and treatment of mothers who are infected. Routine serologic screening should be done at the 1st prenatal visit in all pregnant women and in communities and populations in which the risk for congenital syphilis is high; serologic testing and a sexual history also should be obtained at 28 weeks gestation and at delivery. Groups at high risk include uninsured women, women living in poverty, sex workers, illicit drug users, women diagnosed with sexually transmitted diseases, and those living in communities with high syphilis morbidity (<http://www.ahrq.gov/clinic/uspstf09/syphilis/syphpgsum.htm>). No mother or neonate should leave the hospital without maternal serologic status having been documented at least once during pregnancy and, if the mother is considered high risk, also at delivery.

Reference:
Sidibe M, Singh PK. Thailand eliminates mother-to-child transmission of HIV and syphilis. The Lancet 2016: 387(10037);2488-2489, June 9, 2016 DOI: <https://doi.org/10.1016/S0140-6736(16)30787-5>. - ProMED Mod.ML]

[HealthMap/ProMED map available at:
Thailand: <http://healthmap.org/promed/p/151>]
Date: Thu, 9 May 2019 10:07:07 +0200

Bangkok, May 9, 2019 (AFP) - The closure of the glittering Thai bay made famous by the movie "The Beach" has been extended for another two years to allow a full recovery of its corals and wildlife, an official said Thursday, drawing a sharp rebuke from the tourism industry.    Maya Bay, ringed by cliffs on Ko Phi Phi Ley island and surrounded by azure waters, was made famous when it featured in the 2000 film starring Leonardo Dicaprio.    It was shut last June by Thai authorities due to worries the white-sand paradise was suffering from the pressure of thousands of day-trippers arriving by boat. 

Authorities had initially said the beach -- a massive draw for Thailand's more than 38 million tourists -- was going to be closed for four months, but the re-opening was repeatedly postponed.    Thon Thamrongnawasawat, advisor to the Department of National Parks, told AFP on Thursday the ban on visitors will be extended until mid-2021.   "The resolution of the Department of Parks yesterday is to extend the closure of Maya Bay for another two years to allow its ecology to fully recover," he said.    After it is re-opened, measures such as limiting the number of daily visitors and banning boats from parking within the bay's waters will be enacted, Thon said.

Before Maya Bay's closure, up to 5,000 tourists visited daily, causing trees and smaller vegetation to be uprooted, creeping soil erosion, and severe damage to the corals in the bay.    A majority of the visitors were ferried there from tourist hotspot Krabi province by local longtail boatmen or tour operators who touted the movie-famous bay as a key attraction for day trips.    "Maya Bay is the heart of our tourism," said Wattana Rerngsamut, chairman of Krabi Provincial Tourism Association which represents some 200 tourism and hotel operators.    Calling the two-year extension "unfair", Wattana said the Department of National Parks should conduct public hearings so they can find "common ground... so that local people can earn a living".   Chinese visitors, making up a quarter of Thailand's tourists, have "plunged 50 percent (in Krabi)", he added.

Thailand experienced a three-month slowdown in tourism last year, most noticeably since July when a ferry sank and killed 47 Chinese visitors off nearby Phuket.    Since the tragedy, the government has rolled out inducements aimed at regaining trust and making travel easier -- including exempting Chinese visitors from paying a visa-on-arrival fee.    Less than a year after its closure, blacktip reef sharks have been sighted swimming in Maya Bay, with conservationists saying their return signals signs of a recovery to the ecology.
Date: Tue 30 Apr 2019
Source: Outbreak News Today [edited]
<http://outbreaknewstoday.com/diphtheria-cases-thailand-86317/>

The Thailand Department of Disease Control (DDC) with the Ministry of Public Health (MOPH) reports a diphtheria incidence rate that is 2 times higher than the same period of last year (2018) and also the median of the past 5 years (2014­2018). Through [27 Apr 2019], there had been 9 confirmed diphtheria cases of which 2 died. The patients were found in 6 provinces including Uttaradit, Tak, Suratthani, Sonkhla, Satun, and Yala.

The highest incidence rates occurred among infants and young children less than 5 years old, followed by the 10­19 years age group. Officials say there is a continued risk of sporadic diphtheria in crowded places such as child day-care centres and boarding schools especially in some areas with low diphtheria vaccination coverage.

Diphtheria is an acute bacterial infection of respiratory system, which can cause mild to severe illness. Symptoms develop 2­5 days after infection and include fever, sore throat, and swollen lymph glands in the neck. Severe illness presents with swollen neck and thick grey or white patches of dead tissue in the throat and tonsils caused by the bacterial toxin. Complications are blocking of the airway and absorption of the toxin into the blood stream that may cause damage to the heart, kidneys, and peripheral nerves and thus can lead to death. The severely ill patient must visit a hospital for special medical care immediately to save life.

Diphtheria is spread from person to person, usually through respiratory droplets, from coughing, sneezing, and close contact. A person can also become infected by contact with shared utensils contaminated with the bacteria. Some mild cases can transmit the bacteria to people around them. Recovered patients might not develop immunity against the disease. The best way to prevent diphtheria is to get vaccinated. The DDC therefore advises parents to bring their children to get the complete vaccination series against diphtheria (DTP [diphtheria, tetanus, pertussis] vaccine) as per the MOPH recommended immunization schedule. Pregnant women should also get the dT vaccine as per the schedule.
===========================
[Thailand implemented a routine infant immunization program in 1977, with 2 doses of diphtheria-tetanus toxoids-whole cell pertussis (DTP) vaccine recommended for all infants; in 1982, the recommendation was changed to 3 doses of DTP vaccine for infants; in 1992, the schedule was modified to 5 doses of DTP vaccine at ages 2, 4, 6, and 18 months and 4-6 years; a dose of tetanus and diphtheria toxoids (Td) was recommended at ages 12-16 years (<https://academic.oup.com/jid/article/184/8/1035/807141>).

The number of diphtheria cases initially dropped dramatically after the introduction of the vaccine. However, after reporting cases in the single digits for many years, the number of cases reported more recently jumped. For example, 63 people in Thailand had diphtheria in 2013 and 16 people had the disease in 2014 (<http://outbreaknewstoday.com/thailand-to-begin-diphtheria-vaccination-campaign-27989/>).

A diphtheria vaccine coverage rate of 80-85 percent is thought to be necessary to stop transmission (<http://www.who.int/immunization/sage/meetings/2017/april/2_Review_Diphtheria_results_April2017_final_clean.pdf>). In Thailand, 99% of the infant population is said to have received 3 doses of diphtheria-tetanus toxoid and pertussis vaccine in 2017 (<https://www.who.int/immunization/monitoring_surveillance/data/tha.pdf>).

However, although vaccination rates may be this high in Thailand as a whole, vaccination rates may be much lower in some communities where sporadic diphtheria cases occur. Most complications of diphtheria, including death, are attributable to effects of the toxin. The toxin, when absorbed, affects organs and tissues distant from the site of invasion. The most frequent complications of diphtheria are myocarditis and neuritis, and focal necrosis of liver and kidneys.

Myocarditis may present as abnormal cardiac rhythms and can occur early in the course of the illness or weeks later and can lead to heart failure. Neuritis most often affects motor nerves and usually resolves completely. Paralysis of the soft palate, eye muscles, limbs, and diaphragm can occur. Secondary pneumonia and respiratory failure may result from diaphragmatic paralysis.

Other complications include otitis media and respiratory insufficiency due to airway obstruction, especially in infants. However, _Corynebacterium diphtheriae_ infective endocarditis is mostly due to non-toxigenic strains (<https://www.sciencedirect.com/science/article/pii/S1201971211000920> and <https://www.ncbi.nlm.nih.gov/pubmed/21641260>). - ProMED Mod.ML]

[Maps of Thailand: < http://en.wikipedia.org/wiki/Provinces_of_Thailand>
and <http://healthmap.org/promed/p/151>]
Date: Sun 28 Apr 2019
Source: The Thaiger & The Nation [edited]
<https://thethaiger.com/news/national/surin-man-first-to-die-of-rabies-in-2019>

A 32-year-old man in Surin province has become the 1st person to die of rabies this year [2019]. The Disease Control Department Director-General, Dr Suwannachai Wattanayingcharoenchai, says the man was bitten by a stray dog last November [2018] but never sought an anti-rabies vaccination.  The man developed fever and had difficulty swallowing before lab tests confirmed he had rabies, according to Suwannachai.

Providing advice to reduce chances of contracting rabies (which is already very rare), Suwannachai urged people to have their pets vaccinated annually, which local administrative bodies administer for free from March to June.  "If a cat or a dog scratches or bites you or licks your wound, you have to promptly clean the wound with soap and water repeatedly for about 10 minutes. Then add Povidone-iodine (Betadine) to lower the chance of rabies infection, and see a doctor immediately for diagnosis and vaccination."  "It's also crucial that the animal be monitored for any abnormal symptoms or death within 10 days."  Dr Suwannachai said people should avoid provoking animals lest they be scratched or bitten and take care to avoid stepping on an animal, which could provoke a bite.  "You shouldn't try to break up a cat or dog fight with your bare hands or take away any food they might be eating. It's also best to avoid contact with animals you don't know.
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[Most unfortunately, the victim paid with his life for the tragic mistake: refraining from consulting the health authorities immediately after being bitten by a stray, unfamiliar dog.  The incubation period, in the described case, took nearly 6 months. Thailand officially reported 11 rabies cases (deaths) in humans during 2017, and 14 during 2016 (OIE data). The data for 2018 are not yet available. - ProMED Mod.AS]

[HealthMap/ProMED map available at:
Thailand: <http://healthmap.org/promed/p/151>]
Date: Sat 20 Apr 2019
Source: Outbreak News Today [edited]
<http://outbreaknewstoday.com/streptococcus-suis-infections-thailand-10-deaths-first-three-months-95460/>

The Thailand Division of Disease Control (DDC) with the Ministry of Health (MOH) is warning (computer translated) the public against eating pork that isn't properly cooked due to the risk of _Streptococcus suis_ infection. During the first 3 months of 2019, health officials have reported 50 _S. suis_ infections, including 10 fatalities.

The risk to the community is raw pork dishes mixed with raw pigs blood, like spicy minced pork and spicy blood pork soup.

Human _Streptococcus suis_ infection is a zoonotic infection associated with pigs. The infection can be fatal, particularly if the specific strain produces certain toxins. _S. suis_ infection can manifest itself in meningitis, hearing impairment, toxic shock, septicaemia and endocarditis. It can be contracted either through ingesting raw pork or if it comes in contact with an open wound or mucous membrane.

To prevent the disease, members of the public are advised to always practice personal and environmental hygiene. They should avoid contact with pigs that are sick or dead from diseases and their excreta or body fluid. If contact with pigs or raw pork is necessary, one should: use protective gloves; wash hands after handling pigs or raw pork; and clean and cover all wounds properly.  In 2018, Thailand reported 338 cases and 29 deaths.
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[_Streptococcus suis_ is facultative anaerobic gram-positive alpha-haemolytic coccus that is sub-divided into at least 35 serotypes, based on antigenicity of their capsular polysaccharides (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623174/>); serotypes vary in pathogenicity (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5244560/>). Serotype 2 is the most frequently isolated serotype from diseased animals. _S. suis_ has been isolated from asymptomatic pigs; the natural habitat of _S. suis_ is the upper respiratory tract, particularly the tonsils and nasal cavities, and the genital and alimentary tract of pigs (<https://www.farmhealthonline.com/US/disease-management/pig-diseases/streptococcus-suis/>); but virulent strains can cause serious disease mainly in suckling and recently weaned pigs (polyarthritis, meningitis, and septicaemia) (<https://vetmed.iastate.edu/vdpam/FSVD/swine/index-diseases/streptococcal-infection>).

_S. suis_ can cause potentially fatal zoonotic infection in humans, namely meningitis, septicaemia, and endocarditis (<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC97186/>). Toxic shock may also occur if the strain produces the appropriate toxins.

Human _S. suis_ infection occurs mainly among those who slaughter infected pigs. Eating appropriately cooked meat or organs from infected pigs is said to pose no risk of _S. suis_ infection. However, people who eat raw infected pork and cooks who prepare food from infected pork meat and organs would also be at risk of infection. Person-to-person spread does not seem to occur (see <http://jac.oxfordjournals.org/cgi/content/full/50/2/201>).

Porcine reproductive and respiratory syndrome (PRRS), a viral infection in pigs is known to have an immunosuppressive effect, which is thought to increase pigs' susceptibility to infection with _S. suis_. - ProMED Mod.ML]

[HealthMap/ProMED map available at:
Thailand: <http://healthmap.org/promed/p/151>]
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