Civilian-military malaria outbreak response in Thailand: an example of multi-stakeholder engagement for malaria elimination

Malaria Journal

Andrew A. Lover¹  Prayuth Sudathip²  Preecha Prempree²  Michelle E. Roh³  Adam Bennett³  Roly Gosling³  Sara Rossi³  Chatree Raseebut⁴  Danai Jearakul⁴  Prasert Nonkaew⁴  Peerapol Pokpong⁵  Nithinart Chaitaveep⁵  Sutchana Tabprasit⁵  Wanchai Lausatianragit⁶  Kanyarat Lausatianragit⁶  Mitra Feldman⁷  Philip L. Smith⁷  Michele Spring⁷  Mariusz Wojnarski⁷  Piyaporn Sai-ngam⁷  Chaiyaporn Chaisatit⁷  Montri Arsanok⁷  Sabaithip Sriwichai⁷  Nicholas J. Martin⁷  Krisada Jongsakul⁷  Parat Boonyarangka⁷  Mark M. Fukuda⁷ 

[1] Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts-Amherst, Amherst, Massachusetts, USA;Division of Vector Borne Disease, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand;Malaria Elimination Initiative, Institute of Global Health Sciences, University of California, San Francisco, San Francisco, California, USA;Office of Disease Prevention and Control 10, Ministry of Public Health, Ubon Ratchathani Province, Thailand;Royal Thai Army, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand;Sisaket Provincial Health Office, Sisaket, Sisaket Province, Thailand;US Army Medical Directorate, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand;

关键词: Military;    Civilian;    Malaria;    Malaria outbreak investigation;    Thailand;    Malaria elimination;    Civilian-military cooperation;    Southeast Asia;    Greater Mekong Subregion;   

DOI  :  10.1186/s12936-021-03995-6

来源: Springer

【 摘 要 】

BackgroundIn April 2017, the Thai Ministry of Public Health (MoPH) was alerted to a potential malaria outbreak among civilians and military personnel in Sisaket Province, a highly forested area bordering Cambodia. The objective of this study was to present findings from the joint civilian-military outbreak response.MethodsA mixed-methods approach was used to assess risk factors among cases reported during the 2017 Sisaket malaria outbreak. Routine malaria surveillance data from January 2013 to March 2018 obtained from public and military medical reporting systems and key informant interviews (KIIs) (n = 72) were used to develop hypotheses about potential factors contributing to the outbreak. Joint civilian-military response activities included entomological surveys, mass screen and treat (MSAT) and vector control campaigns, and scale-up of the “1–3–7” reactive case detection approach among civilians alongside a pilot “1–3–7” study conducted by the Royal Thai Army (RTA).ResultsBetween May–July 2017, the monthly number of MoPH-reported cases surpassed the epidemic threshold. Outbreak cases detected through the MoPH mainly consisted of Thai males (87%), working as rubber tappers (62%) or military/border police (15%), and Plasmodium vivax infections (73%). Compared to cases from the previous year (May–July 2016), outbreak cases were more likely to be rubber tappers (OR = 14.89 [95% CI: 5.79–38.29]; p < 0.001) and infected with P. vivax (OR=2.32 [1.27–4.22]; p = 0.006). Themes from KIIs were congruent with findings from routine surveillance data. Though limited risk factor information was available from military cases, findings from RTA’s “1–3–7” study indicated transmission was likely occurring outside military bases. Data from entomological surveys and MSAT campaigns support this hypothesis, as vectors were mostly exophagic and parasite prevalence from MSAT campaigns was very low (range: 0-0.7% by PCR/microscopy).ConclusionsIn 2017, an outbreak of mainly P. vivax occurred in Sisaket Province, affecting mainly military and rubber tappers. Vector control use was limited to the home/military barracks, indicating that additional interventions were needed during high-risk forest travel periods. Importantly, this outbreak catalyzed joint civilian-military collaborations and integration of the RTA into the national malaria elimination strategy (NMES). The Sisaket outbreak response serves as an example of how civilian and military public health systems can collaborate to advance national malaria elimination goals in Southeast Asia and beyond.

【 授权许可】

CC BY