Objective: On 1 December 2020, the Department of Disease Control of Thailand was notified of a cluster of food poisoning cases among participants at a church festival in Mae Ai district, Chiang Mai province. We conducted an outbreak investigation to confirm diagnosis, describe the epidemiological characteristics of the outbreak, identify possible sources of the outbreak and provide appropriate control measures. Methods:We reviewed medical records of the food poisoning cases from the health care centres. Active case finding was conducted among participants who had consumed food and water at the festival. An environmental survey was done in the village where the festival was held. A case-control study was conducted to identify the source of the outbreak. Samples for laboratory analysis included rectal swabs and fresh stool specimens from the cases and food handlers, surface swabs of cooking equipment, food, water and ice samples.Results: Among 436 participants surveyed, 368 (84.4%) cases of food poisoning were identified. The most common clinical manifestation was abdominal pain (89.7%), followed by watery diarrhoea (45.7%), nausea (43.5%), vomiting (38.9%), fever (18.5%) and bloody diarrhoea (4.6%). None died in this outbreak. The case-control study showed that mixed spicy seafood salad served in the festival was significantly associated with the disease by both univariable and multivariable analyses. However, the causative agent could not be identified. The environmental investigation suggested this seafood might have been undercooked. Conclusion:Clinical manifestations of the cases, incubation period and the suspected seafood salad suggested seafood-related food poisoning. Grimontia hollisae, the organism causing illness similar to Vibrio parahaemolyticus and commonly undetectable in the laboratory with routine testing, might be the pathogen that caused this outbreak.G. hollisae should be in differential diagnosis and identified in seafood-associated outbreaks.
On 16 Sep 2021, Thailand's Division of Epidemiology, was notified of an outbreak of coronavirus disease 2019 (COVID-19) in a garment factory in Tak Province. An outbreak investigation was conducted to determine epidemiological characteristics of cases, identify risk factors associated with infection, and recommend appropriate preventive measures. A review of COVID-19 surveillance data and outbreak reports was performed. An active case finding was conducted among the factory workers. We interviewed the manager and workers of the factory and performed an environmental observation and conducted a case-control study. Logistic regression models were employed. Of 242 workers tested for severe acute respiratory syndrome coronavirus 2 by rapid antigen test kit, 90 (37.2%) were found positive. The attack rate was highest in the sewing department (47.4%) and among female workers (53.8%). The prevalence of asymptomatic infection was 15.6%. One case with pneumonia was found and there were no deaths. Working in the sewing department was a significant risk factor [adjusted odds ratio (OR) 3.15, 95% confidence interval (CI) 1.01–9.79] while mask wearing [adjusted OR 0.34, 95% CI 0.14–0.82] was a protective factor. Overcrowding and poorly ventilated conditions were observed in the workplace. Our investigation confirmed a COVID-19 outbreak in a garment factory. Reorienting the environment and strengthening individual protective measures, such as mandatory mask wearing and physical distancing amongst the workers, are recommended.
On October 2020, there was a bus-train collision at Chachoengsao Province with 18 fatalities. The Division of Epidemiology conducted a joint investigation during October 2020 to describe characteristics of the event and deaths, and identify factors associated with fatalities. A descriptive study was conducted by interviewing officers, witnesses, policemen, rescuers and survivors. We also reviewed medical records and closed-circuit television and performed environmental survey of the roads and bus wreckage. A retrospective cohort study was performed with multiple logistic regression and Haddon matrix analyses. The bus collided with a cargo train at an illegal road-railway crossing intersection. Eighteen people died (25.4%). Most deaths were caused by lethal injuries to the head and neck (17/18, 94.4%). The bus was overloaded and turning on loud music. The intersection did not have crossing gates and the warning signal was broken. This bus-train collision resulted in high fatality. Standing on the overloaded bus was the significant risk of death. Regulations of noise limits, number of passengers, limit standing on the buses, and improvement of safety controls for all road-railway intersections should be strictly implemented for injury prevention.
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