Authors

Michelle E. Roh, University of California, San Francisco
Kanyat Lausatianragit, Sisaket Provincial Health Office
Nithinart Chaitaveep, Armed Forces Research Institute of Medical Sciences
Krisada Jongsakul, Armed Forces Research Institute of Medical Sciences
Prayuth Sudathip, Ministry of Public Health, Nonthaburi, Thailand
Chatree Raseebut, Ministry of Public Health, Ubon Ratchathani Province, Thailand
Sutchana Tabprasit, Armed Forces Research Institute of Medical Sciences
Prasert Nonkaew, Ministry of Public Health, Ubon Ratchathani Province, Thailand
Michele Spring, Armed Forces Research Institute of Medical Sciences
Montri Arsanok, Armed Forces Research Institute of Medical Sciences
Parat Boonyarangka, Armed Forces Research Institute of Medical Sciences
Sabaithip Sriwichai, Armed Forces Research Institute of Medical Sciences
Piayporn Sai-ngam, Armed Forces Research Institute of Medical Sciences
Chaiyaporn Chaisatit, Armed Forces Research Institute of Medical Sciences
Peerapol Pokpong, Armed Forces Research Institute of Medical Sciences
Preecha Prempree, Ministry of Public Health, Nonthaburi, Thailand
Sara Rossi, University of California, San Francisco
Mita Feldman, Armed Forces Research Institute of Medical Sciences
Mariusz Wojnarski, Armed Forces Research Institute of Medical Sciences
Adam Bennett, University of California, San Francisco
Roly Gosling, University of California, San Francisco
Danai Jearakul, Ministry of Public Health, Ubon Ratchathani Province
Wanchai Lausatianragit, Sisaket Provincial Health Office
Philip L. Smith, Armed Forces Research Institute of Medical Sciences
Nicholas J. Martin, Armed Forces Research Institute of Medical Sciences
Andrew A. Lover, University of Massachusetts Amherst
Mark M. Fukuda, Armed Forces Research Institute of Medical Sciences

Publication Date

2021

Journal or Book Title

Malaria Journal

Abstract

Background

In 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.

Methods

A 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).

Results

Between 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).

Conclusions

In 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.

License

UMass Amherst Open Access Policy

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