Objectives: The objective of this study was to evaluate and injury surveillance (IS) system's ability to monitor road traffic deaths and the coverage of road traffic injury and death surveillance in Phuket, Thailand. Methods: U.S. Centers for Disease Control and Prevention guidelines on surveillance system evaluation were used to qualitatively and quantitatively evaluate IS. Interviews with key stakeholders focused on IS's usefulness, simplicity, flexibility, acceptability, and stability. Active case finding of 2014 road traffic deaths in all paper and electronic hospital record systems was used to assess system sensitivity, positive predictive value, and data quality. Electronic data matching software was used to determine the implications of combining IS data with other provincial-level data sources (e.g., death certificates, electronic vehicle insurance claim system). Results: Evaluation results indicated that IS was useful, flexible, acceptable, and stable, with a high positive predictive value (99%). Simplicity was limited due to the burden of collecting data on all injuries and use of paper-based data collection forms. Sensitivity was low, with IS only identifying 55% of hospital road traffic death cases identified during active case finding; however, IS cases were representative of cases identified. Data accuracy and completeness varied across data fields. Combining IS with active case finding, death certificates, and the electronic vehicle insurance claim system more than doubled the number of road traffic death cases identified in Phuket.

On 31 May 2019, the Division of Epidemiology (DoE) was notified of a confirmed extensively drug-resistant tuberculosis (XDR-TB) case in Bangkok. The DoE and local teams conducted a joint investigation to describe the epidemiological characteristics of the case, identify possible source cases and contacts, and implement control measures. A descriptive study was performed among cases and close contacts by interviewing and reviewing the medical records using a standard case definition. An environmental study was performed at the case's house, workplaces, and tuberculosis (TB) clinic. The TB drugs were tested to analyze the content of active ingredients and dissolution. The case was a 36-year-old Thai male. In 2011, he was diagnosed with pulmonary tuberculosis and had received inappropriate treatment. He developed multidrug-resistant tuberculosis (MDR-TB) eight months later and XDR-TB in May 2019 with delayed hospital admission. Two possible source cases, both co-workers of the index case, were identified. Of 21 contacts, 13 were screened with a chest x-ray and found to have no abnormality. At the TB-clinic, drugs were stored in a room with inappropriate levels of temperature and humidity; however, the content of active ingredients and dissolution of TB drugs were within normal limits. Early hospital admission and monitoring of drug stockpile environments according to standard guidelines are recommended.

In July 2011, catastrophic flooding occurred in 65 out of 77 provinces in Thailand, affecting 9.5 million and caused 813 deaths. The highest number of death due to floodwater was found in Phichit Province. An investigation was conducted to identify risk factors for flood-related mortality. A matched case-control study was performed. A case was defined as a flood-related death and the matched control was a person residing in the same neighborhood within five years age range. Data on cases were gathered by interview with family members and witnesses while information on controls was obtained through a structured questionnaire. Total 50 flood-related deaths and 100 controls were enrolled. Majority of deaths (56%) were 31-60 years old. About 87% of deaths were males and the cause of all deaths was drowning (100%). Health problems such as central nervous system disorder, psychosis and epilepsy were observed among 34% of the deaths. A common activity at the time of death was fishing (44%). Having health problem (adjusted OR=17.3, 95% CI=1.1-275.5) and male gender (adjusted OR=14.6, 95% CI=1.4-154.2) were identified as independent risk factors of flood-related deaths. Risk communication was initiated with the related ministries and high risk activities in the floodwater were prohibited by the responsible ministries.

On 6 Oct 2015, the Thailand Bureau of Epidemiology was notified of a food poisoning outbreak among students in a primary school. An investigation was performed to verify the diagnosis and outbreak, describe epidemiological characteristics, identify the source, and provide proper recommendations in order to prevent further outbreaks. Descriptive and retrospective cohort studies were conducted. Medical records at the hospital were reviewed, and teachers, students, cooks and janitors from the school were interviewed. A suspected case was a person in the school with at least two of the followings: nausea, vomiting, abdominal pain or diarrhea during 5-9 Oct 2015. The water samples were sent to the National Institute of Health for bacterial culture. The suspected plant was examined at the Plant Varieties Protection Division for species identification. Bivariate analysis was used to determine the food items associated with illness. The attack rate was 28.8% with 19 suspected cases out of total 66. Most common symptoms included nausea (85.0%), vomiting (85.0%) and abdominal pain (60.0%). All of the suspected cases consumed the coral plant (Jatropha multifida), which was also the only significant risk for the illness (P value <0.001). Therefore, this event was a coral plant poisoning outbreak. To prevent future outbreaks, a fence around the herb garden with a warning sign should be set up in the school, along with adequate warning of herb toxicity.

On 16 Dec 2016, the Bureau of Epidemiology in the Ministry of Public Health, Thailand, was notified of a suspected echovirus 6 encephalitis death in Samut Prakan Province. An investigation was launched for active case detection and confirmation of causative agent. Out of 32 people identified, two (6.3%) were confirmed for echovirus 6, including the index case, and there were 30 suspected cases. The index case was a 5-year-old Thai boy and kindergarten student. On 8 Dec 2015, he developed encephalitis. Echovirus 6 was detected in his cerebrospinal fluid, nasal and rectal swab samples. Chest x-ray revealed pulmonary edema and elevated cardiac enzyme as signs of rhombencephalitis. There were also five (2.9%) out of 173 asymptomatic contacts tested positive for echovirus 6 infection. Potential risks for infection were sharing of utensils and toys, and playing together. Lack of intensive health screening in the school and inadequate hand washing facilities were also observed. We recommended households and the school to improve sanitation, and health education was provided in the communities and schools. Physician's knowledge and awareness of echovirus infection among children should be raised to provide proper treatment and early referral if needed.