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The epidemiology of melioidosis in Ubon Ratchatani, northeast Thailand
Y Suputtamongkol1, A J Hall, D A Dance
1Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Background:
Melioidosis, or infection with Pseudomonas pseudomallei is an important cause of morbidity and mortality in South East Asia and Northern Australia. The epidemiology of melioidosis in Ubon Ratchatani, Northeast Thailand was studied over a 5-year period from 1987 to 1991.
Methods:
Rates and, when possible, the risks of developing melioidosis were calculated. The numerator was the number of culture-proven cases of melioidosis seen in the 1000-bed referral hospital of the province. The denominators were obtained from the population census, a survey of Health, Welfare and Use of Traditional Medicine, and the North Eastern Meterological Centre, Thailand.
Results:
The average incidence of human melioidosis was 4.4 (95% confidence interval [CI]: 3.8-5.0) per 100,000. The disease affected all ages with the highest incidence in 40-60 years olds. Melioidosis was 1.4 (95% CI: 0.4-5.3) times more common in males than females. The disease showed a significant seasonal variation in incidence, and a strong linear correlation with rainfall (r = 0.7, 95% CI: 0.5-0.9) Adults exposed to soil and water in their work (most were rice farmers) had an increased risk of melioidosis (in the 40-59 year age group, relative risk = 4.1, 95% CI: 2.4-6.9). Most adult patients had an underlying disease (mainly diabetes mellitus) predisposing them to this infection.
Conclusion:
Melioidosis may result from either acute exposure to the organism in the soil and water, or 're-activation' of an asymptomatic childhood infection (by an unidentified possibly infective seasonal cofactor). The results from this analysis are consistent with both hypotheses. Further epidemiological studies are needed to identify risk factors so that optimal strategies for control of melioidosis may be developed.
Insights
Melioidosis, a serious infection caused by Pseudomonas pseudomallei, occurs frequently in Northeast Thailand, particularly during rainy seasons. Rice farmers and individuals with diabetes are at higher risk, suggesting environmental and health factors are key to this disease.
Area of Science:
- Epidemiology
- Infectious Diseases
- Public Health
Background:
- Melioidosis (Pseudomonas pseudomallei infection) is a significant cause of illness and death in Southeast Asia and Northern Australia.
- This study investigated the epidemiology of melioidosis in Ubon Ratchatani, Northeast Thailand, over a five-year period (1987-1991).
Purpose of the Study:
- To determine the incidence and risk factors of melioidosis in Northeast Thailand.
- To understand the seasonal patterns and environmental correlations of melioidosis outbreaks.
Main Methods:
- Culture-proven melioidosis cases were identified from a provincial referral hospital.
- Population census data, health surveys, and meteorological records provided denominators and environmental data.
- Incidence rates and relative risks were calculated for different demographic groups and exposure scenarios.
Main Results:
- The average annual incidence of melioidosis was 4.4 per 100,000 population.
- The highest incidence was observed in adults aged 40-60 years, with males being more affected than females.
- Melioidosis incidence strongly correlated with rainfall, and occupational exposure to soil/water (e.g., rice farmers) increased risk, especially in adults with underlying conditions like diabetes mellitus.
Conclusions:
- Melioidosis transmission may involve acute environmental exposure or reactivation of latent infections, possibly influenced by seasonal cofactors.
- Identifying specific risk factors is crucial for developing effective control strategies for melioidosis.
- Further epidemiological research is recommended to refine prevention and management approaches.