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Abstract This analytical cross-sectional study aimed to determine factors influencing knowledge, attitudes, and practices (KAP) toward the swine influenza virus (SIV) among pig farm owners, workers, and villagers in selected provinces of Thailand. This study was carried out from February to December 2022 in pig farms and villages across the provinces. A structured and standardized quantitative questionnaire was utilized to collect data on socio-demographic variables and KAP related to SIV from 215 participants. The quantitative data was analyzed in two steps using R software. The study findings showed that the average knowledge score on SIV was 6.92 out of 12, indicating moderate understanding of SIV in study participants. Attitudes towards SIV were generally positive, with an average score of 3.74 out of 5. Practices for SIV prevention averaged a score of 3.63 out of 5. Key factors associated with better SIV knowledge included higher education levels, higher monthly income, and direct involvement in vaccination processes. Moreover, those with higher education, employment on pig farms, and prior vaccination experience showed more positive attitudes towards SIV. Occupations related to pig farming and the availability of vaccination services significantly influenced SIV prevention practices. The findings highlighted that improved education and stronger connections with healthcare professionals and the pig farming sector may significantly enhance KAP regarding SIV among targeted populations. In contrast, participants with limited exposure to health services or pig farming activities, such as nearby villagers, require specialized educational interventions. This study recommends that local health authorities should develop and implement communication strategies and interventions focused on educating pig farm owners, managers, and villagers about SIV to mitigate the risks associated with SIV and other zoonotic diseases.

Abstract This concurrent qualitative study was carried out with the main objective to determine wildlife beliefs, taboos, usages, health perceptions, and practices among ten ethnic groups in four communities in Tak and Mae Hong Son provinces of Thailand from November 2020 to January 2021. We also gathered comprehensive information on study respondents’ knowledge related to potential risk behaviors that could lead to zoonotic disease transmission and infection. Furthermore, we intended to use the study’s findings to develop communication strategies and health literacy improvement interventions for mitigating risky behaviors, with a focus on ethnic groups and particular individuals who live in close proximity to forests and wildlife, to prevent future pandemics. Sixty-five respondents were purposively selected based on their extensive knowledge, active participation in local cultural contexts, beliefs, and exposure to wildlife contact or consuming game animals. Twenty (30.8%) participated in in-depth interviews (IDIs), while 45 (69.2%) participated in eight focused group discussions (FGDs). The results revealed that the characteristics of wildlife contact are similar and distinct based on their beliefs and taboos among various ethnic groups and study locations, which are influenced by cultural backgrounds and traditions. Although some ethnic groups do not have explicit restrictions on the consumption of wildlife, others adhere to specific beliefs and taboos that forbid the consumption or killing of specific wild animals. These beliefs frequently correspond with conservation initiatives, thereby facilitating the preservation of threatened species. The study also revealed a lack of appropriate health knowledge, perceptions, and practices regarding wildlife contact and consumption. As a result, it is recommended that public health officials and local governments develop and execute communication and education initiatives. These campaigns should aim to increase health literacy and promote safe handling, preparation, and cooking practices to reduce the risk of zoonotic disease transmission and infection effectively. Moreover, it is necessary to design and implement wildlife conservation education and outreach activities. The programs should promote environmental stewardship while considering the cultural contexts, beliefs, and practices of various ethnic groups. The activities should involve diverse stakeholders, including local leaders, religious influencers, community members, schoolteachers, students, health professionals, village health volunteers, and civil society organizations.

Mani, or Maniq, or Sakai, are recognized as indigenous hunter-gatherers. Some are nomadic, while others have settled and modernized. Our knowledge of this ethnic group's healthcare-seeking and wildlife contact is limited. Thus, this qualitative study examined healthcare practices and wildlife interaction among a cluster of Mani ethnic group members in Manang District, Satun Province, Thailand, from November to December 2022.Four key informant interviews (KIIs) and focus group discussions (FGDs) were carried out, and the selection of the study respondents was based on information from a gatekeeper and local health officials. Coding, thematic, content, and triangulation analyses of audio transcriptions were implemented based on the study objectives.Mani's beliefs and lifestyle are deeply rooted in the forest, which significantly impacts numerous aspects of their lives. They encountered challenges such as food scarcity, legal issues, and access to modern healthcare. However, since obtaining national identification cards, their mobility has decreased. Their way of life has also changed, as they've become more dependent on outsiders. Nevertheless, they continue engaging in traditional practices such as gathering food, hunting in the forest, and treating illnesses with herbal remedies. They rarely develop serious illnesses. They have decided to seek treatment only if their condition persists or worsens. In addition, their knowledge of COVID-19, zoonotic diseases, and emerging animal-borne diseases was limited. In this regard, relevant governments and organizations should improve their health literacy about zoonotic diseases spread by wild animals to promote appropriate wildlife contact practices and reduce the potential risk of infection.

Summary: Background: Repurposed drugs with host-directed antiviral and immunomodulatory properties have shown promise in the treatment of COVID-19, but few trials have studied combinations of these agents. The aim of this trial was to assess the effectiveness of affordable, widely available, repurposed drugs used in combination for treatment of COVID-19, which may be particularly relevant to low-resource countries. Methods: We conducted an open-label, randomized, outpatient, controlled trial in Thailand from October 1, 2021, to June 21, 2022, to assess whether early treatment within 48-h of symptoms onset with combinations of fluvoxamine, bromhexine, cyproheptadine, and niclosamide, given to adults with confirmed mild SARS-CoV-2 infection, can prevent 28-day clinical deterioration compared to standard care. Participants were randomly assigned to receive treatment with fluvoxamine alone, fluvoxamine + bromhexine, fluvoxamine + cyproheptadine, niclosamide + bromhexine, or standard care. The primary outcome measured was clinical deterioration within 9, 14, or 28 days using a 6-point ordinal scale. This trial is registered with ClinicalTrials.gov (NCT05087381). Findings: Among 1900 recruited, a total of 995 participants completed the trial. No participants had clinical deterioration by day 9, 14, or 28 days among those treated with fluvoxamine plus bromhexine (0%), fluvoxamine plus cyproheptadine (0%), or niclosamide plus bromhexine (0%). Nine participants (5.6%) in the fluvoxamine arm had clinical deterioration by day 28, requiring low-flow oxygen. In contrast, most standard care arm participants had clinical deterioration by 9, 14, and 28 days. By day 9, 32.7% (110) of patients in the standard care arm had been hospitalized without requiring supplemental oxygen but needing ongoing medical care. By day 28, this percentage increased to 37.5% (21). Additionally, 20.8% (70) of patients in the standard care arm required low-flow oxygen by day 9, and 12.5% (16) needed non-invasive or mechanical ventilation by day 28. All treated groups significantly differed from the standard care group by days 9, 14, and 28 (p

Summary: This study investigated the potential of using SARS-CoV-2 viral concentrations in dust as an additional surveillance tool for early detection and monitoring of COVID-19 transmission. Dust samples were collected from 8 public locations in 16 districts of Bangkok, Thailand, from June to August 2021. SARS-CoV-2 RNA concentrations in dust were quantified, and their correlation with community case incidence was assessed. Our findings revealed a positive correlation between viral concentrations detected in dust and the relative risk of COVID-19. The highest risk was observed with no delay (0-day lag), and this risk gradually decreased as the lag time increased. We observed an overall decline in viral concentrations in public places during lockdown, closely associated with reduced human mobility. The effective reproduction number for COVID-19 transmission remained above one throughout the study period, suggesting that transmission may persist in locations beyond public areas even after the lockdown measures were in place.

Summary: Equitable SARS-CoV-2 surveillance in low-resource communities lacking centralized sewers is critical as wastewater-based epidemiology (WBE) progresses. However, large-scale studies on SARS-CoV-2 detection in wastewater from low-and middle-income countries is limited because of economic and technical reasons. In this study, wastewater samples were collected twice a month from 186 urban and rural subdistricts in nine provinces of Thailand mostly having decentralized and non-sewered sanitation infrastructure and analyzed for SARS-CoV-2 RNA variants using allele-specific RT-qPCR. Wastewater SARS-CoV-2 RNA concentration was used to estimate the real-time incidence and time-varying effective reproduction number (Re). Results showed an increase in SARS-CoV-2 RNA concentrations in wastewater from urban and rural areas 14–20 days earlier than infected individuals were officially reported. It also showed that community/food markets were “hot spots” for infected people. This approach offers an opportunity for early detection of transmission surges, allowing preparedness and potentially mitigating significant outbreaks at both spatial and temporal scales.

Abstract Background Bats serve as an important reservoir for emerging infectious diseases. Bat contact and consumption, which persists in Asia, poses risks for the transmission of bat-borne infections. Methods An analytical cross-sectional survey for risk factors associated with bat contact and consumption behaviors was conducted in ten provinces of Thailand from May 2016 to December 2017. A standardized questionnaire administered through face-to-face interviews was used to collect information from 626 villagers who lived in or nearby areas of high bat density. The questionnaire contained 23 independent variables related to sociodemographic, knowledge, attitudes, practices, and perceptions. Results The respondents (n = 626) were 285 females and 341 males, mean age of respondents was 47.58 years-old and lived in rural setting. Our results showed that 36.42% of respondents (n1 = 228) in 10 provinces reported bat contact during the past 6 months. Furthermore, 15.34% of respondents (n2 = 96) in 9 out of 10 provinces reported of having consumed bat meat in the past 6 months. Risk factors for bat contact included sex (male) (OR = 1.56, 95% CI 1.09–2.28), educational attainment (lower than secondary school) (OR = 1.45, 95% CI 1.02–2.18), and the consideration of bats as being economically beneficial to the community (OR = 3.18, 95% CI 2.03–4.97), while agriculture-related occupation (OR = 0.54, 95% CI 0.37–0.79), knowledge that it is safe to eat bats (OR = 0.58, 95% CI 0.37–0.93), practice of allowing children to play with bats (OR = 0.65, 95% CI 0.44–0.96), and attitude of feeling safe in areas where bats live (OR = 0.56, 95% CI 0.38–0.86) were statistically significant protective factors against bat contact. Risk factors for bat consumption included sex (male) (OR = 2.48, 95% CI 1.49–4.11) and educational attainment (lower than secondary school) (OR = 2.21, 95% CI 1.27–3.85), while knowledge of whether bats are safe to eat (OR = 0.04, 95% CI 0.01–0.25), knowledge of whether there are laws pertaining to hunting bats for consumption (OR = 0.35, 95% CI 0.18–0.71), and the practice of allowing children to play with bats (OR = 0.51, 95% CI 0.31–0.81) were statistically significant protective factors against bat consumption. Conclusions This study provides a better understanding of the sociodemographic factors, knowledge, attitudes, perceptions and practices that might influence bat contact and bat consumption behaviors. Information on risk factors can be used for the development of appropriate education and communication interventions to promote proper knowledge, attitudes and practices regarding bats and bat-borne zoonotic diseases in Thailand and other areas in the Southeast Asia region with similar environmental and cultural characteristics.

Bats are wildlife and distribute globally. In Thailand, there are hundreds of bat species in different locations within four regions. However, few motivations and influences for having contact with bats have been documented. This sequential qualitative study was conducted in ten provinces representing the four regions of Thailand from September 2016 to June 2017. The study was designed to obtain information on villagers' attitudes, perceptions, beliefs and cultural contexts in relation to bats. Focus group discussions (FGDs) were conducted with 305 respondents. Of these respondents, 142 (46.6%) reported coming into contact with bats through various activities, such as hunting, eating, cooking, collecting bat guano, cleaning bat feces, and finding carcasses in houses and communities. Villagers called bats by different names in different regions. They reported having been in contact with bats in different ways based on occupations, bat species, bat habitats, attitudes, perceptions, beliefs toward bats, and cultural contexts. Villagers in the northern and northeastern regions reported having regularly eaten bats. In contrast, the respondents in the central region did not eat bats due to local norms, religious beliefs, and regulations. By ethnicity, the Blu and Thai Dum groups reported coming into contact with and eating bats more often than the Thais. Our results provide evidence-based information on the human-bat interface in different regions in Thailand. The results of this qualitative study could be useful for strategic planning of proper education and interventions for bat conservation, bat contact behavior, and risk of bat-borne diseases among villagers in the future.

Background: Repurposed drugs with host-directed antiviral and immunomodulatory properties have shown promise in the treatment of COVID-19, but few trials have studied combinations of these agents. The aim of this trial was to assess the effectiveness of affordable, widely available, repurposed drugs used in combination for treatment of COVID-19, which may be particularly relevant to low-resource countries., Methods: We conducted an open-label, randomized, outpatient, controlled trial in Thailand from October 1, 2021, to June 21, 2022, to assess whether early treatment within 48-h of symptoms onset with combinations of fluvoxamine, bromhexine, cyproheptadine, and niclosamide, given to adults with confirmed mild SARS-CoV-2 infection, can prevent 28-day clinical deterioration compared to standard care. Participants were randomly assigned to receive treatment with fluvoxamine alone, fluvoxamine + bromhexine, fluvoxamine + cyproheptadine, niclosamide + bromhexine, or standard care. The primary outcome measured was clinical deterioration within 9, 14, or 28 days using a 6-point ordinal scale. This trial is registered with ClinicalTrials.gov (NCT05087381)., Findings: Among 1900 recruited, a total of 995 participants completed the trial. No participants had clinical deterioration by day 9, 14, or 28 days among those treated with fluvoxamine plus bromhexine (0%), fluvoxamine plus cyproheptadine (0%), or niclosamide plus bromhexine (0%). Nine participants (5.6%) in the fluvoxamine arm had clinical deterioration by day 28, requiring low-flow oxygen. In contrast, most standard care arm participants had clinical deterioration by 9, 14, and 28 days. By day 9, 32.7% (110) of patients in the standard care arm had been hospitalized without requiring supplemental oxygen but needing ongoing medical care. By day 28, this percentage increased to 37.5% (21). Additionally, 20.8% (70) of patients in the standard care arm required low-flow oxygen by day 9, and 12.5% (16) needed non-invasive or mechanical ventilation by day 28. All treated groups significantly differed from the standard care group by days 9, 14, and 28 (p < 0.0001). Also, by day 28, the three 2-drug treatments were significantly better than the fluvoxamine arm (p < 0.0001). No deaths occurred in any study group. Compared to standard care, participants treated with the combination agents had significantly decreased viral loads as early as day 3 of treatment (p < 0.0001), decreased levels of serum cytokines interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and interleukin-1 beta (IL-1β) as early as day 5 of treatment, and interleukin-8 (IL-8) by day 7 of treatment (p < 0.0001) and lower incidence of post-acute sequelae of COVID-19 (PASC) symptoms (p < 0.0001). 23 serious adverse events occurred in the standard care arm, while only 1 serious adverse event was reported in the fluvoxamine arm, and zero serious adverse events occurred in the other arms., Interpretation: Early treatment with these combinations among outpatients diagnosed with COVID-19 was associated with lower likelihood of clinical deterioration, and with significant and rapid reduction in the viral load and serum cytokines, and with lower burden of PASC symptoms. When started very soon after symptom onset, these repurposed drugs have high potential to prevent clinical deterioration and death in vaccinated and unvaccinated COVID-19 patients., Funding: Ped Thai Su Phai (Thai Ducks Fighting Danger) social giver group., Competing Interests: Dr. Reiersen is listed as an inventor on a patent application related to methods of treating COVID-19 (including Sigma1 agonists and specifically fluvoxamine), which was filed by Washington University in St. Louis. No other author declares any potential conflict of interest or competing financial or non-financial interest in relation to the manuscript., (© 2024 The Author(s).)

Mani, or Maniq, or Sakai, are recognized as indigenous hunter-gatherers. Some are nomadic, while others have settled and modernized. Our knowledge of this ethnic group's healthcare-seeking and wildlife contact is limited. Thus, this qualitative study examined healthcare practices and wildlife interaction among a cluster of Mani ethnic group members in Manang District, Satun Province, Thailand, from November to December 2022. Four key informant interviews (KIIs) and focus group discussions (FGDs) were carried out, and the selection of the study respondents was based on information from a gatekeeper and local health officials. Coding, thematic, content, and triangulation analyses of audio transcriptions were implemented based on the study objectives. Mani's beliefs and lifestyle are deeply rooted in the forest, which significantly impacts numerous aspects of their lives. They encountered challenges such as food scarcity, legal issues, and access to modern healthcare. However, since obtaining national identification cards, their mobility has decreased. Their way of life has also changed, as they've become more dependent on outsiders. Nevertheless, they continue engaging in traditional practices such as gathering food, hunting in the forest, and treating illnesses with herbal remedies. They rarely develop serious illnesses. They have decided to seek treatment only if their condition persists or worsens. In addition, their knowledge of COVID-19, zoonotic diseases, and emerging animal-borne diseases was limited. In this regard, relevant governments and organizations should improve their health literacy about zoonotic diseases spread by wild animals to promote appropriate wildlife contact practices and reduce the potential risk of infection., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article., (© 2024 The Authors.)

This study investigated the potential of using SARS-CoV-2 viral concentrations in dust as an additional surveillance tool for early detection and monitoring of COVID-19 transmission. Dust samples were collected from 8 public locations in 16 districts of Bangkok, Thailand, from June to August 2021. SARS-CoV-2 RNA concentrations in dust were quantified, and their correlation with community case incidence was assessed. Our findings revealed a positive correlation between viral concentrations detected in dust and the relative risk of COVID-19. The highest risk was observed with no delay (0-day lag), and this risk gradually decreased as the lag time increased. We observed an overall decline in viral concentrations in public places during lockdown, closely associated with reduced human mobility. The effective reproduction number for COVID-19 transmission remained above one throughout the study period, suggesting that transmission may persist in locations beyond public areas even after the lockdown measures were in place., Competing Interests: The authors declare no competing interests., (© 2024 The Author(s).)

Equitable SARS-CoV-2 surveillance in low-resource communities lacking centralized sewers is critical as wastewater-based epidemiology (WBE) progresses. However, large-scale studies on SARS-CoV-2 detection in wastewater from low-and middle-income countries is limited because of economic and technical reasons. In this study, wastewater samples were collected twice a month from 186 urban and rural subdistricts in nine provinces of Thailand mostly having decentralized and non-sewered sanitation infrastructure and analyzed for SARS-CoV-2 RNA variants using allele-specific RT-qPCR. Wastewater SARS-CoV-2 RNA concentration was used to estimate the real-time incidence and time-varying effective reproduction number (R e ). Results showed an increase in SARS-CoV-2 RNA concentrations in wastewater from urban and rural areas 14-20 days earlier than infected individuals were officially reported. It also showed that community/food markets were "hot spots" for infected people. This approach offers an opportunity for early detection of transmission surges, allowing preparedness and potentially mitigating significant outbreaks at both spatial and temporal scales., Competing Interests: No author declares any potential conflict of interest or competing financial or non-financial interest in relation to the manuscript., (© 2023 The Author(s).)

Bats are wildlife and distribute globally. In Thailand, there are hundreds of bat species in different locations within four regions. However, few motivations and influences for having contact with bats have been documented. This sequential qualitative study was conducted in ten provinces representing the four regions of Thailand from September 2016 to June 2017. The study was designed to obtain information on villagers' attitudes, perceptions, beliefs and cultural contexts in relation to bats. Focus group discussions (FGDs) were conducted with 305 respondents. Of these respondents, 142 (46.6%) reported coming into contact with bats through various activities, such as hunting, eating, cooking, collecting bat guano, cleaning bat feces, and finding carcasses in houses and communities. Villagers called bats by different names in different regions. They reported having been in contact with bats in different ways based on occupations, bat species, bat habitats, attitudes, perceptions, beliefs toward bats, and cultural contexts. Villagers in the northern and northeastern regions reported having regularly eaten bats. In contrast, the respondents in the central region did not eat bats due to local norms, religious beliefs, and regulations. By ethnicity, the Blu and Thai Dum groups reported coming into contact with and eating bats more often than the Thais. Our results provide evidence-based information on the human-bat interface in different regions in Thailand. The results of this qualitative study could be useful for strategic planning of proper education and interventions for bat conservation, bat contact behavior, and risk of bat-borne diseases among villagers in the future., (© 2020 The Authors.)