Problems in human rabies post-exposure prophylaxis management

This is a prospective study of problems encountered with rabies-exposed patients in an animal bite clinic in a rabies endemic region. Five hundred successive patients were analyzed. The study focused mainly on issues that are not well covered in current WHO and US-CDC rabies manuals. Those dealing with immunoglobulin administration, managing severe and unusual injuries, logistic and financial issues headed the list. Animal bite patients often present challenging problems, which are not or inadequately addressed in official publications. Experience and good clinical judgment are essential in preventing human rabies.     

The way forward

Good public-health decisionmaking is dependent on reliable and timely statistics on births and deaths (including the medical causes of death). All high-income countries, without exception, have national civil registration systems that record these events and generate regular, frequent, and timely vital statistics. By contrast, these statistics are not available in many low-income and lower-middle-income countries, even though it is in such settings that premature mortality is most severe and the need for robust evidence to back decisionmaking most critical. Civil registration also has a range of benefits for individuals in terms of legal status, and the protection of economic, social, and human rights. However, over the past 30 years, the global health and development community has failed to provide the needed technical and financial support to countries to develop civil registration systems. There is no single blueprint for establishing and maintaining such systems and ensuring the availability of sound vital statistics. Each country faces a different set of challenges, and strategies must be tailored accordingly. There are steps that can be taken, however, and we propose an approach that couples the application of methods to generate better vital statistics in the short term with capacity-building for comprehensive civil registration systems in the long run.     

Influenza‐associated mortality in Thailand, 2006–2011

Background

Influenza-associated mortality in subtropical or tropical regions, particularly in developing countries, remains poorly quantified and often underestimated. We analyzed data in Thailand, a middle-income tropical country with good vital statistics and influenza surveillance data.

Methods

We obtained weekly mortality data for all-cause and three underlying causes of death (circulatory and respiratory diseases, and pneumonia and influenza), and weekly influenza virus data, from 2006 to 2011. A negative binomial regression model was used to estimate deaths attributable to influenza in two age groups (<65 and ≥65 years) by incorporating influenza viral data as covariates in the model.

Results

From 2006 to 2011, the average annual influenza-associated mortality per 100 000 persons was 4·0 (95% CI: −18 to 26). Eighty-three percent of influenza-associated deaths occurred among persons aged > 65 years. The average annual rate of influenza-associated deaths was 0·7 (95% CI: −8·2 to 10) per 100 000 population for person aged <65 years and 42 (95% CI: −137 to 216) for person aged ≥ 65 years.

Discussion

In Thailand, estimated excess mortality associated with influenza was considerable even during non-pandemic years. These data provide support for Thailand''s seasonal influenza vaccination campaign. Continued monitoring of mortality data is important to assess impact.     

Effects of Russell's viper venom fractions on systemic and renal hemodynamics.

Changes in systemic and renal hemodynamics induced by Russell's viper venom are well established. The component of the venom responsible for hemodynamic alteration has not been identified. By Sephadex column chromatography five fractions of Russell's viper (Daboia russellii siamensis) venom were isolated. Each venom fraction consisted of phospholipase A2, proteolytic enzyme, phosphomonoesterase, phosphodiesterase, arginine ester hydrolase and hyaluronidase of varying activities. Hemodynamic effects of each venom fraction including mean arterial pressure, cardiac output, systemic and renal vascular resistance, renal blood flow and glomerular filtration rate were studied in five groups of dogs; each group had four dogs. Minimal hemodynamic changes were observed in dogs receiving venom fraction I. Increased renal vascular resistance with diminution of renal blood flow and glomerular filtration rate was observed in dogs receiving venom fractions II, III, IV and V. A markedly increased renal vascular resistance with maximal decrease in renal blood flow and glomerular filtration rate was caused by fraction III of the venom with highest PLA2 and proteolytic enzyme activities. However, renal hemodynamic changes appeared to correlate better with proteolytic enzyme activity than PLA2 activity. The findings suggested the proteolytic enzyme as an important determinant of hemodynamic alteration. Fractional excretion of Na was increased in dogs injected with venom fraction IV, and is presumed to be due to the inhibition of tubular reabsorption of Na by a natriuretic factor in this venom fraction.     

Correcting and estimating HIV mortality in Thailand based on 2005 verbal autopsy data focusing on demographic factors, 1996-2009

Background

It is known that death registry (DR) underestimates HIV deaths. The objectives of this study were to examine under-reporting/misclassification and to estimate HIV mortality in Thailand during 1996-2009 from a model based on 2005 verbal autopsy (VA) data.

Methods

Logistic regression was used to predict HIV deaths from the VA dataset with and without demographic covariates. This full model was then used to predict individual HIV deaths from the DR dataset of provinces in which VA was conducted. The proportions in the remaining provinces were predicted from spatial interpolation based on coefficients of the VA provinces.

Results

Area under Receiver Operating Characteristic curve of the full model was 0.969 compared to 0.879 of the simple cross-referencing model when demographic covariates were not included. DR-reported HIV deaths accounted for only one-third of all VA-estimated HIV deaths. The most misclassified HIV deaths were those registered as tuberculosis and mental and nervous system. Under-reporting was most common among females and people aged 20-39 years, and effect of province was highest in the upper north and upper south regions.

Conclusions

For approximately two-thirds of all HIV deaths estimated by the full model, the causes were reported under other categories, not HIV. Demographic variables are essential for accurately correcting causes of death from death registries.

     

Burden of disease in Thailand: changes in health gap between 1999 and 2004

Background  

Continuing comprehensive assessment of population health gap is essential for effective health planning. This paper assessed changes in the magnitude and pattern of disease burden in Thailand between 1999 and 2004. It further drew lessons learned from applying the global burden of disease (GBD) methods to the Thai context for other developing country settings.     

Infectious Disease Mortality Rates,Thailand, 1958–2009

To better define infectious diseases of concern in Thailand, trends in the mortality rate during 1958–2009 were analyzed by using data from public health statistics reports. From 1958 to the mid-1990s, the rate of infectious disease–associated deaths declined 5-fold (from 163.4 deaths/100,000 population in 1958 to 29.5/100,000 in 1997). This average annual reduction of 3.2 deaths/100,000 population was largely attributed to declines in deaths related to malaria, tuberculosis, pneumonia, and gastrointestinal infections. However, during 1998–2003, the mortality rate increased (peak of 70.0 deaths/100,000 population in 2003), coinciding with increases in mortality rate from AIDS, tuberculosis, and pneumonia. During 2004–2009, the rate declined to 41.0 deaths/100,000 population, coinciding with a decrease in AIDS-related deaths. The emergence of AIDS and the increase in tuberculosis- and pneumonia-related deaths in the late twentieth century emphasize the need to direct resources and efforts to the control of emerging and re-emerging infectious diseases.     

Is injecting a finger with rabies immunoglobulin dangerous?

Treating potentially rabies virus infected wounds requires the injection of rabies immunoglobulin into and around the wounds, followed by vaccination with an approved tissue culture rabies vaccine. A significant number of such bite wounds involves fingers where there is little space for expansion. Injecting immunoglobulin into such areas under pressure may induce a compartment syndrome caused by compromising circulation. We carried out a retrospective review and a prospective study of patients seen with digital bite injuries and found that it is a safe procedure if carried out with care by experienced staff.     

Polydrug use among kratom users: Findings from the 2011 Thailand National Household Survey

Despite the availability of numerous anecdotal reports of polydrug use in kratom users, few studies have been carried out in Thailand. This study aimed to explore the problem of polydrug use among Thai kratom users. A national household survey on the prevalence of substance use was conducted in 2011 using a multistage random sampling technique. Participants were interviewed using a structured questionnaire. The frequency of other substance use was compared between respondents with and without a history of kratom use. Of the total sample (18,457), 544 (2.9%) acknowledged kratom use. Eighty-nine (46.1%) used it almost every day. The mean age of users (SD) was 42.7 (12.8) years old, 459 (84.4%) were male, and 264 (48.5%) had used other illicit drugs in the past. Kratom users were significantly more likely to use heroin, ecstasy, and ice with adjusted odds ratios of 39.7, 30.5, and 29.1, respectively. Of 195 who acknowledged kratom use in the past 12 months, 22 (11.3%) concurrently used other illicit drugs, including cannabis, amphetamine-type stimulants (ATSs), and inhalants. Polydrug use is common in Thai kratom users who are more likely to use opiates and ATSs in their lifetime. Another drug concurrently used was cannabis. Health personnel need to be aware of polydrug use in this population.