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Thailand

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Overview

The collaboration between Thailand’s Ministry of Public Health (MOPH) and the U.S. Centers for Disease Control and Prevention (CDC) began in 2001 and represents the first field site of the International Emerging Infections Program (IEIP). Headquartered on the campus of the MOPH, about 30 minutes north of downtown Bangkok, IEIP-Thailand is part of the broader Thailand MOPH – U.S. CDC (TUC) collaboration that includes the Global AIDS Program (GAP), HIV/AIDS research activities, tuberculosis surveillance, an advisor to the Field Epidemiology and Training Program (FETP) and Immigrant and Refugee Health activities. With the stated mission of strengthening Thai capacity to identify and control emerging infections of regional and global significance, IEIP-Thailand focuses on the five pillars of activity – surveillance, research, outbreak response and preparedness, training and capacity building, and networking. The priorities of the IEIP-Thailand are developed collaboratively in weekly meetings of the Thailand MOPH IEIP working group, whose members are listed below.

Selected Activities

Thailand Ministry of Public Health

Population-based surveillance for severe pneumonia

IEIP-Thailand conducts active, population-based surveillance for pneumonia in two provinces, Sa Kaeo on the border with Cambodia, and Nakhon Phanom, bordering Laos. Surveillance for hospitalized cases of community-acquired pneumonia is conducted in all district (18) and provincial (2) hospitals in these provinces. Community surveys have been conducted to assess health care access and estimate the incidence of pneumonia occurring outside the hospital setting. Research studies and enhanced microbiologic capacity allow for estimation of the incidence of pathogen-specific pneumonia, including both common causes (e.g., influenza, RSV, Streptococcus pneumoniae) and emerging or re-emerging diseases (e.g., bocavirus, melioidosis). Enhanced microbiology is supported through funding from the PneumoADIP.  Please see the standard operating procedures for routine blood cultures.
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Research focused on the control and prevention of emerging infectious diseases

Research priorities are developed collaboratively in regular meetings of the MOPH-IEIP working group. IEIP staff work closely with Thai partners in the MOPH and academia, other government partners, and subject matter experts at the U.S. CDC. Research studies are also designed to build local laboratory capacity by training Thailand scientists in the key testing procedures used in the studies. Through local and CDC partnerships, three large research studies have been conducted since 2002:

• Febrile Illness Study. This prospective study to determine the etiologies of febrile illness was conducted in three rural provinces in Thailand. The study initially focused on the burden of leptospirosis and dengue but identified many other less well-documented causes of infection, including Rickettsia and Bartonella species. Over the course of the study at least one novel species of Bartonella was identified and a new culture system was developed in collaboration with CDC-Ft. Collins.

• Encephalitis Study. This study prospectively enrolled patients at referral hospitals in Bangkok and a southern Thailand province to determine etiologies of encephalitis. Japanese encephalitis (JE) was found to be the most common cause of encephalitis, leading to improved understanding of the epidemiology of JE in a country with a routine childhood vaccination program.

• Respiratory Pathogen Study. This ongoing study enrolls hospitalized patients with clinical pneumonia. Nasopharyngeal, serum, and urine specimens are tested for multiple viral and bacterial pathogens. An outpatient component of the study focuses on causes of influenza-like illness and has greatly improved our understanding of the epidemiology and associated costs of influenza in Thailand.

Outbreak response and preparedness

IEIP-Thailand serves as a resource for Thailand and the region by supporting investigation and control of emerging infectious disease outbreaks and by training personnel in surveillance and laboratory techniques. IEIP collaborates frequently with Thailand’s FETP and directly supports training for Thailand’s extensive network of Surveillance and Rapid Response Teams. Besides collaborative support for field investigations and laboratory operations, the platform offers epidemiological assistance, clinical resources, and critical supplies to ensure rapid, comprehensive responses to national and regional emergencies. Collaborative facilities include BSL3 and BSL2 laboratories in the Bangkok metropolitan region with real-time and conventional PCR, DNA/RNA sequencing, immunodiagnostics, bacterial and viral culture, and wide-ranging statistical and field epidemiology expertise.

Training and capacity-building

IEIP provides and supports professional training and development through conferences, courses, training workshops, and mentoring programs and activities. In addition, IEIP supports development and capacity-building in the area of informatics for modern surveillance and communication technology.

Development of a laboratory network for detection and control of emerging infectious diseases and enhanced laboratory capacity

In partnership with the MOPH laboratories and collaborators at CDC-Atlanta and CDC-Ft. Collins, IEIP-Thailand performs immunological, microbiological, and molecular testing to detect or isolate infectious agents to support the clinical and epidemiological studies. If approved by the working group and the MOPH, some laboratory testing may occur in collaborating research labs outside of Thailand, depending upon programmatic needs and national priorities. Through regional outreach, national laboratory capacity is also being developed by IEIP-Thailand in Cambodia, Indonesia, Laos, Vietnam, and the Philippines.

Key Accomplishments

• Active, population-based surveillance for hospitalized pneumonia has been established in two sites, covering a population of 1.2 million.  These sites provide important information about pneumonia etiology and burden of disease in Thailand.  In addition, they offer unique opportunities to evaluate the effectiveness of pharmaceutical (including vaccines) and non-pharmaceutical interventions to prevent pneumonia.  Surveillance for pneumonia and influenza has proved especially useful during a period when sensitive detection systems for avian influenza cases are vital.
• State-of-the-art automated blood culture systems were implemented in Sa Kaeo and Nakhon Phanom to improve diagnosis and treatment of pneumonia and sepsis.
• An influenza section within IEIP has been established to coordinate the array of influenza research, programmatic, and training activities.
• IEIP-Thailand has developed, organized, and hosted numerous large national and regional training workshops and conferences, including three laboratory workshops focused on molecular diagnostics for avian influenza, which included staff from Thailand and several other countries; a five day train-the-trainer workshop for rapid response to avian influenza outbreaks, attended by close to 100 staff from over 15 countries in Asia, Africa, and Latin America; three symposiums on risk communication theory and techniques; annual scientific and training workshops for Thailand’s Surveillance and Rapid Response Teams; and Geographic Information Systems (GIS) courses.
• IEIP arranged and supported mentorship and training opportunities that have allowed Thai scientists to spend extended periods working at CDC facilities in the U.S. and have provided U.S. fellows with first-hand learning opportunities during field assignments to IEIP-Thailand.

For updates on the IEIP in Thailand, please browse current and past newsletters.

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