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Kitro A, Imad HA, Pisutsan P, Matsee W, Sirikul W, Sapbamrer R, Rapheal E, Fernandez S, Cotrone TS, Farmer AR, Hunsawong T, Silachamroon U, Chatapat L, Olanwijitwong J, Salee P, Anderson KB, Piyaphanee W. Seroprevalence of dengue, Japanese encephalitis and Zika among long-term expatriates in Thailand. J Travel Med 2024; 31:taae022. [PMID: 38335250 DOI: 10.1093/jtm/taae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/04/2024] [Accepted: 02/05/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Travel to Southeast Asia increases the likelihood of acquiring mosquito-borne Flavivirus infections such as dengue (DENV), Japanese encephalitis (JEV) and Zika viruses (ZIKV). Expatriates are long-term travellers who have a higher risk of mosquito-borne illness at their destination country. The purpose of this study was to evaluate the seroprevalence of DENV, JEV and ZIKV infections and the determinants contributing to seropositivity among expatriates living in Thailand. METHODS A cross-sectional study was performed from December 2017 to February 2020. Expatriates from non-Flavivirus endemic countries were recruited. 5 mL of blood was collected for DENV 1-4, JEV and ZIKV antibody testing by plaque reduction neutralization test (PRNT50). Individuals with vaccination histories or diagnoses for dengue, Japanese encephalitis, yellow fever and tick-borne encephalitis were excluded. RESULTS Among 254 participants, most participants (83.1%) were male, the mean age was 65 years and the median duration of stay in Thailand was 6 years. Seroprevalence rate of any Flavivirus, non-specific DENV, DENV1-4, JEV and ZIKV were 34.3, 30.7, 20.5, 18.1, 18.9, 10.6, 4.7 and 2.8%, respectively. The presence of neutralizing antibodies against DENV1-4 positively correlates with the duration of stay in Thailand. DENV seropositivity was associated with living in urban areas (aOR 2.75, 95% CI 1.36-5.57). Expatriates were unlikely to have detectable anti-JEV antibodies regardless of time spent in a JEV-endemic area. No risk factors were identified that were significantly associated with JEV or ZIKV seropositivity. Only 48.4% received pre-travel counselling services, while only 18.9% visited a travel medicine specialist. CONCLUSIONS A high proportion (34.3%) of long-term expatriates living in Thailand were seropositive for flavivirus, mainly from dengue (30.7%). To minimize risk, travel medicine practitioners should provide adequate pre-travel health risk information on mosquito-borne flavivirus infection and offer advice on mosquito bite prevention strategies. Dengue vaccine might be considered in high-risk travellers such as long-term expatriate.
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Affiliation(s)
- Amornphat Kitro
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Environmental and Occupational Medicine Excellence Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Hisham Ahmed Imad
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Center for Infectious Disease Education and Research, Department of Viral Infections, Research Institute for Microbial Diseases, Osaka University, Osaka, Suita 565-0871, Japan
| | - Phimphan Pisutsan
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Wasin Matsee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Wachiranun Sirikul
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Center of Data Analytics and Knowledge Synthesis for Health Care, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Ratana Sapbamrer
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Environmental and Occupational Medicine Excellence Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Erica Rapheal
- School of Public Health, University of Minnesota, Minnesota, MN 55414, USA
| | - Stefan Fernandez
- Department of Virology, US Army Medical Directorate of the Armed Force Research Institute of Medical Sciences, Bangkok 10400, Thailand
| | - Thomas S Cotrone
- Department of Virology, US Army Medical Directorate of the Armed Force Research Institute of Medical Sciences, Bangkok 10400, Thailand
| | - Aaron R Farmer
- Department of Virology, US Army Medical Directorate of the Armed Force Research Institute of Medical Sciences, Bangkok 10400, Thailand
| | - Taweewun Hunsawong
- Department of Virology, US Army Medical Directorate of the Armed Force Research Institute of Medical Sciences, Bangkok 10400, Thailand
| | - Udomsak Silachamroon
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Lapakorn Chatapat
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Jutarmas Olanwijitwong
- Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Parichat Salee
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Kathryn B Anderson
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY 13210, USA
- Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Watcharapong Piyaphanee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
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Hiranrusme T, Piyaphanee W, Kaewkungwal J, Silachamroon U, Leowattana W, Chatapat L, Matsee W. Risk perception of health problems among travelers visiting a travel clinic in Bangkok, Thailand. Trop Dis Travel Med Vaccines 2020; 6:7. [PMID: 32477584 PMCID: PMC7238588 DOI: 10.1186/s40794-020-00108-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/08/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Effective pre-travel consultations cannot be achieved only through individual risk assessment and advice on vaccinations and chemoprophylaxis. Travelers' perceptions of the risk of health problems represent another key factor in successful risk communication and co-operation with pre-travel advice. The objective of this study was to determine perception of travel-related health risks among Thais and westerners visiting the Thai Travel Clinic for consultation before visiting developing countries. METHODS A novel pictorial scale questionnaire-based study was conducted with both Thai and western travelers who visited the Thai Travel Clinic for pre-travel consultation. All participants were approached before and after completing the consultation, and were asked about their demographic data and perceptions of travel-related health risk. The perceptions of risk before and after consultation were compared using the McNemar test, and were also compared with the actual estimated risk. RESULTS During May to November 2019, 594 travelers (330 Thais and 264 Westerners) were enrolled and completed the pictorial scale questionnaires. Most Thai travelers visited Africa/South America (63%), and 20% had previously received counseling. Westerners were mostly backpackers (37.5%), traveling for > 30 days (71.6%), while 43.6% had previously received counseling. Overall, the westerners (n = 264) changed their risk perceptions slightly after counseling in contrast with the Thais. The change in perception of most health problems was observed statistically significant (p-value < 0.05) after receiving pre-travel consultation among both groups of travelers. Risk perception among western travelers after consultation compared with estimated actual risk showed accurate risk perception toward most of health problems especially in travelers who had previously received counseling in ones' home countries. CONCLUSIONS Risk perception of health problems plays an important role in successful risk communication and their response to pre-travel advices. Differences in risk perceptions were evident between the two groups. Therefore, this highlight the importance of obtaining pre-travel advice in one's home country before travelling. Raised awareness of the risks should be emphasized during consultations for underestimated health risks, especially for rabid animal exposure and sexually transmitted diseases.
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Affiliation(s)
- Thanyapat Hiranrusme
- 1Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Watcharapong Piyaphanee
- 1Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Jaranit Kaewkungwal
- 2Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Udomsak Silachamroon
- 1Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Wattana Leowattana
- 1Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Lapakorn Chatapat
- 1Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Wasin Matsee
- 1Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
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Matsee W, Chatapat L, Chotivanich K, Piyaphanee W. Case Report: A Cluster of Plasmodium falciparum Malaria Cases among Thai Workers in Gembu, Nigeria. Am J Trop Med Hyg 2018; 99:623-626. [PMID: 30014824 DOI: 10.4269/ajtmh.18-0367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Although falciparum malaria is an important risk among travelers to sub-Saharan Africa, many travelers remain unaware of this risk. In October 2015, we found a cluster of imported Plasmodium falciparum malaria cases among Thai gem mine workers in Nigeria; none had received malaria chemoprophylaxis or information regarding malaria risk. The index case developed fever and visited our hospital on arrival day in Thailand after his 3-week stay in Nigeria. Plasmodium falciparum was found in his blood. He recovered completely 3 days post-admission. After we requested he contact his colleagues in Nigeria regarding malaria risk, we found that three of his five colleagues currently had fever, were diagnosed with malaria, and were being treated in a local hospital. Two were successfully treated in Nigeria. Although their blood films were negative for malaria, we could confirm that they recently had malaria because the polymerase chain reaction (PCR) was still positive for P. falciparum. Tragically, the last febrile case died in Nigeria 6 days post-admission, after developing jaundice and alteration of consciousness. The two colleagues without fever symptoms were also tested by PCR, which was negative for malaria. In conclusion, we found that four of six workers had malaria in this cluster, which was equal to 66.7% attack rate. There is an urgent need to raise awareness of malaria among workers in highly endemic areas. Clinical practice for travelers who are ill on their return should not only focus on individual cases but also consider potential disease clusters.
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Affiliation(s)
- Wasin Matsee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Lapakorn Chatapat
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kesinee Chotivanich
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Watcharapong Piyaphanee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Olanwijitwong J, Lawpoolsri S, Ponam T, Puengpholpool P, Sharma C, Chatapat L, Pawan V, Kittitrakul C, Piyaphanee W. Incidence and spectrum of health problems among travellers to Myanmar. J Travel Med 2018; 25:4711110. [PMID: 29232462 DOI: 10.1093/jtm/tax077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/31/2017] [Indexed: 11/13/2022]
Abstract
BACKGROUND The number of international travellers visiting Myanmar increases each year. However, information about pre-travel preparation and incidence of health problems among these travellers is limited. METHODS This cross-sectional study was conducted at three international airports in Thailand. Travellers returning from Myanmar completed questionnaires querying demographic profile, pre-travel health preparations and health problems during their stay in Myanmar. RESULTS From March 2015 to May 2017, we collected and analysed questionnaires completed by 397 Thai and 467 non-Thai travellers (total: 50.1% men, median age 37 years). Non-Thai travellers were from Europe (59%), Northern America (21.4%), Asia (16.5%) and Australia or New Zealand (3.0%). Approximately 74% of non-Thais sought pre-travel health information; only 36% of Thais did so. Tourism was the main purpose for travel among both Thais (58.4%) and non-Thais (85.2%). Non-Thais were more likely than Thais to travel as backpackers and perform outdoor activities such as trekking, cycling or swimming. The average length of stay in Myanmar among non-Thais was significantly longer than that of Thais (26.58 days vs 7.08 days, P < 0.001). Health problems were reported by 22.9% of non-Thais; the most common was diarrhoea (21.0%) followed by upper respiratory tract symptoms (9.2%), fever (3.4%) and skin problems (3.0%). Only 12.6% of Thais reported health problems, the most common being upper respiratory tract symptoms (7.6%), followed by diarrhoea (3.1%), fever (2.8%) and skin problems (2.0%). Most health problems were mild and self-limited in both groups. Only one Thai and eight non-Thai travellers required a doctor's visit during their trip to Myanmar, and two non-Thais required hospitalization. CONCLUSIONS Health problems are not very common among travellers to Myanmar. Overall, health problems were reported among 18.2% of travellers in our study. Most problems were mild, with spontaneous recovery. Only two foreign travellers required hospitalization.
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Affiliation(s)
- Jutarmas Olanwijitwong
- Faculty of Tropical Medicine, Hospital for Tropical Diseases, Mahidol University, Bangkok, Thailand
| | - Saranath Lawpoolsri
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Thitiya Ponam
- Faculty of Tropical Medicine, Hospital for Tropical Diseases, Mahidol University, Bangkok, Thailand
| | | | | | - Lapakorn Chatapat
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Chatporn Kittitrakul
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Watcharapong Piyaphanee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Choovichian V, Chatapat L, Piyaphanee W. A Bubble Turtle: Bullous Contact Dermatitis After a Black Henna Tattoo in a Backpacker in Thailand. J Travel Med 2015; 22:287-8. [PMID: 26146821 DOI: 10.1111/jtm.12202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 02/16/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Vorada Choovichian
- Department of Clinical Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Lapakorn Chatapat
- Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Thewjitcharoen Y, Krittiyawong S, Porramatikul S, Parksook W, Chatapat L, Watchareejirachot O, Sripatpong J, Himathongkam T. Outcomes of hospitalized diabetic foot patients in a multi-disciplinary team setting: Thailand's experience. J Clin Transl Endocrinol 2014; 1:187-191. [PMID: 29159100 PMCID: PMC5685051 DOI: 10.1016/j.jcte.2014.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 10/03/2014] [Accepted: 10/06/2014] [Indexed: 12/13/2022]
Abstract
Aims The aims of this study were to evaluate the outcomes of treatment among hospitalized patients with diabetic foot ulcers, the risk factors for non-healing ulcers, and the rate of major amputation among Thai patients. Methods A retrospective study of hospitalized diabetic foot patients treated at Theptarin Hospital during the period of 2009–2013. The complete healing rate was assessed at 12 months after admission. Results During the study period, 232 patients (123 males and 109 females) with 262 admissions were included (mean age 65.6 ± 11.9 years, mean duration of diabetes 17.2 ± 9.9 years) with a mean follow-up of 17.5 ± 16.7 months. Major amputations were performed in 4.2% of the patients and peripheral vascular disease (PVD) was a predictive factor (OR 5.25; 95% CI [1.43–19.29]; p-value 0.006). Complete healing (including minor amputations) was achieved in 82.1% of the admissions. Only DFU of the heel was a statistically significant (OR 3.34; 95% CI [1.11–10.24]; p-value 0.041) predictor of non-healing ulcers. Three patients (1.1%) died during hospitalization. Conclusions Management of diabetes-related foot ulcers with a multidisciplinary approach resulted in a limb salvage rate that was greater than 90% and a complete healing rate that was greater than 80%. Successful management of diabetic foot ulcers might be possible in Thailand utilizing this approach.
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Affiliation(s)
- Yotsapon Thewjitcharoen
- Diabetes and Thyroid Center, Theptarin Hospital, 3858 Rama IV Rd, Klong Toey, Bangkok 10110, Thailand
| | - Sirinate Krittiyawong
- Diabetes and Thyroid Center, Theptarin Hospital, 3858 Rama IV Rd, Klong Toey, Bangkok 10110, Thailand
| | - Sriurai Porramatikul
- Diabetes and Thyroid Center, Theptarin Hospital, 3858 Rama IV Rd, Klong Toey, Bangkok 10110, Thailand
| | - Wyn Parksook
- Diabetes and Thyroid Center, Theptarin Hospital, 3858 Rama IV Rd, Klong Toey, Bangkok 10110, Thailand
| | - Lapakorn Chatapat
- Diabetes and Thyroid Center, Theptarin Hospital, 3858 Rama IV Rd, Klong Toey, Bangkok 10110, Thailand
| | - Orawan Watchareejirachot
- Diabetes and Thyroid Center, Theptarin Hospital, 3858 Rama IV Rd, Klong Toey, Bangkok 10110, Thailand
| | - Jeeraphan Sripatpong
- Diabetes and Thyroid Center, Theptarin Hospital, 3858 Rama IV Rd, Klong Toey, Bangkok 10110, Thailand
| | - Thep Himathongkam
- Diabetes and Thyroid Center, Theptarin Hospital, 3858 Rama IV Rd, Klong Toey, Bangkok 10110, Thailand
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