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OBJECTIVE: To evaluate the epidemiology of thoracolumbar spine injuries when travelling by speedboat to our coastal tertiary trauma center, and to identify injury patterns and mechanism of injury of these specific injuries and to determine the link of the position when seated on board with the risk of thoracolumbar injury in this type of transportation. MATERIALS AND METHODS: A retrospective review of a consecutive series of 80 patients sustaining thoracolumbar spine injuries after travelling by speed boat was conducted. The enrolled patients were treated at a Level II trauma center over a 2-year period from July 1, 2016 to May 31, 2018. All the victims were unrestrained passengers on board a speedboat travelling at high speed without any safety regulation except a life jacket. Initially, a full evaluation with advance trauma life support protocol on arrival was performed. Plain radiographs, computed thermography or MRI study was obtained individually. Number, level and type of thoracolumbar injury were recorded and reported based on CT scan and Thoracolumbar Injury Classification by AO group. The link to the position when seated on board with the incidence of thoracolumbar spine injury was then analyzed and compared relatively. RESULTS: There were a total of 80 patients in our study, 48 (60%) were men and 32 (40%) were women with a mean age of 47.50 years (Min 20, Max 71). All the spinal fractures were a single level injury. The injury occurred only at the thoracolumbar area, these involved 6 cases (7.5%) of T11 vertebra, 20 cases (25%) of T12 vertebra, 44 cases (55%) of L1 vertebra and 10 cases (12.5%) of L2 vertebra respectively. No cervical or sacral region injury was observed nor other associated injuries such as traumatic brain injury, intra-abdominal organ injury or long bone fracture. A spinal cord/nerve root injury occurred in the lumbar region in 1 patient (1.25%). All of the 80 injuries were type A injury (compression type), classified by AO Spine Thoracolumbar Injury Classification, and included 32 levels (40%) of subtype A1, 18 levels (22.5%) of subtype A2, 8 levels (10%) of subtype A3 and 22 levels (27.5%) of subtype A4. 50 cases (62.5%) were treated non-operatively with bracing while 30 cases (37.5) were treated operatively with computer navigation spinal surgery using pedicle screws and rods construction before the patient was discharged or repatriated. Patients who sat in the front row seat were significantly at higher risk for thoracolumbar spine injury (p < 0.05; odds ratio = 41.83; 95%CI: 15.24, 114.8). No patient who sat at the rear reported having had this kind of injury. CONCLUSIONS: Our data shows a high incidence of this unique compressive type of thoracolumbar spine injury in patients who sit in the front row seat while travelling on board a speed boat. As a result of an increasing recognition of these regional-specific injuries, practitioners who take responsibility for trauma patients on the coastal area should be aware of the high prevalence of these injuries. Proper universal spinal precautions must be followed to optimize treatment outcomes. Current safety regulations including speed limits, proper safety restraining techniques, bracing position on board and marine rescuers should be reviewed or changed to minimize the number of injuries and degree of damage. Keywords: thoracolumbar spine, spine injury, speedboat, epidemiology Address Correspondence to author: Narote Treenarong, MD Department of Orthopedic Bangkok Hospital Phuket 2/1 Hongyok-Utis Road, Phuket 83000, Thailand. email: narote.tr@bgh.co.th Received: June 1, 2018 Revision received: June 6, 2018 Accepted after revision: July 11, 2018 BKK Med J 2018;14(2): 22-27. DOI: 10.31524/bkkmedj.2018.09.005

OBJECTIVES: This study proposes using relative weights (RW) of specific health conditions or diagnoses as a simple tool to differentiate simple from not-simple disease cases. MATERIALAND METHODS: Using data from 1,558 records of closed chart review, conducted by Utilization Management and Third-party-payer Services (UM) of Bangkok Dusit Medical Services (BDMS) and a list of simple diseases advised by five health insurance partners, we compared discriminating power of various RW levels. Scenario assessment was conducted to quantify number of cases that could be missed out and turn into risk management (RM) cases. RESULT: RW of 0.3 could categorize 22 (71%) of 31 conditions as simple diseases while RW of 0.4 had the power to categorize 27 (87%) and RW of 0.8 could categorize 31 (100%) of the whole list. Scenario assessment showed increasing risk management (RM) cases from 8 cases using RW = 0.3 to 42 cases (5.3 folds) using RW = 0.4 and to 141 cases (17.6 folds) when RW = 0.8 was used. Although greater RW threshold could capture greater proportion of simple diseases, it could result exponentially increase of RM cases. As a result, RW = 0.4 would be the optimum and practical cut-off point to differentiate simple from not-simple diseases. To monitor hospital performance, different levels of “Percentage of simple disease” should be applied due to different complexity (indicated by case mixed index-CMI) of hospitals in BDMS network. We propose “Yellow zones” of 10%-20% for super tertiary care (CMI > 2.0), 40% - 50% for hub tertiary care (CMI 1.00 – 1.99), 60% - 70% for basic tertiary care (CMI 0.50 – 0.99) and 70% - 80% for secondary care (CMI < 0.5) hospitals. Only continuous monitoring is required when performance stays below these yellow zones. However, when the proportion of simple disease is in the yellow zones, hospital management should pay specific attention. If the situation progressed and theproportion is higher than the upper limit of the yellow zone, special interventions of hospital management and insurance partners would be urgently required. CONCLUSION: Our data showed that RW of 0.4 was the optimum threshold to differentiate simple from not-simple diseases as it could cover 87% of the current list of simple diseases with minimum number of possible RM cases. Different ranges of proportions of simple diseases are proposed for different complexity of BDMS hospitals according to their case complexity, reflected by case mixed index (CMI). More studies using data from other networks are recommended for broader application of this concept.

OBJECTIVE: We describe the Bangkok Dusit Medical Services Surveillance System(BDMS-SS) and use of surveillance efforts for influenza as an example of surveillancecapability in near real-time among a network of 20 hospitals in the Bangkok DusitMedical Services group (BDMS). MATERIALS AND METHODS: The BDMS has a comprehensive network oflaboratory, epidemiologic, and early warning surveillance systems which represents thelargest body of information from private hospitals across Thailand. Hospitals andclinical laboratories have deployed automatic reporting mechanisms since 2010 andhave effectively improved timeliness of laboratory data reporting. In April 2017, thecapacity of near real-time influenza surveillance in BDMS was found to have ademonstrated and sustainable capability. RESULTS: : From October 2010 to April 2017, the real-time laboratory basedsurveillance system automatically uploaded test results and associated data which were24 hours available to affiliated physicians, infectious nurses, local and national publichealth users. A total of 482,789 subjects were tested and 86,177 (17.84%) cases ofinfluenza were identified. Of those positive cases, 40,552 (47.0%) were influenza typeB, 31,412 (36.4%) were influenza A unspecified subtype, 6,181 (7.2%) were influenzaA H1N1, 4,001 (4.6%) were influenza A H3N2, 3,835 (4.4%) were influenza Aseasonal and 196 (0.4%) were respiratory syncytial virus. CONCLUSION: This system was the first near real-time influenza surveillance systemin Thailand. This illustrates a high level of awareness and willingness among the BDMShospital network to report emerging infectious diseases, and highlights the robust andsensitive nature of BDMS’s surveillance system. It demonstrates the flexibility of thesurveillance systems in BDMS to adapt to major communicable diseases. BDMS canmore actively collaborate with national counterparts and use its expertise to strengthenglobal and regional surveillance capacity in Southeast Asia, in order to secureadvances for a world safe and secure from infectious disease.

In response to the rapidly changing occupational health environment, Bangkok DusitMedical Services (BDMS) has recognized a need to increase the quality and availabilityof occupational health services. This manuscript describes the evolution of aninternational health alliance, based on the “twinning” framework, to achieve acollaborative goal of developing an Occupational Health Center of Excellence(COE-OH) in Thailand. Through this alliance, the COE-OH has supported thedevelopment of programs in the areas of health promotion, training and research. Thetwinning framework was applied as the alliance moved through initiation, implementation,monitoring and evaluation. Project evaluation was viewed as an iterative process thatinformed next steps in the process as the collaboration developed. Initial products ofthis alliance include adaptation of the “Let’s Get Healthy!” health promotion and datacollection tool for use as part of the Thai employee check-up; development andimplementation of occupational health trainings for various levels of clinical staff;student exchange opportunities; and the creation of the infrastructure to supportstanding up of a fully human subjects compliant data repository for research. Threeyears into this alliance, the COE-OH has reached a point where feasibility has beenestablished and the immense opportunities of future joint work have become apparent.

Objective: We describe the Bangkok Dusit Medical Services Surveillance System (BDMS-SS) and use of surveillance efforts for influenza as an example of surveillance capability in near real-time among a network of 20 hospitals in the Bangkok Dusit Medical Services group (BDMS).Introduction: Influenza is one of the significant causes of morbidity and mortality globally. Previous studies have demonstrated the benefit of laboratory surveillance and its capability to accurately detect influenza outbreaks earlier than syndromic surveillance.1-3 Current laboratory surveillance has an approximately 4-week lag due to laboratory test turn-around time, data collection and data analysis. As part of strengthening influenza virus surveillance in response to the 2009 influenza A (H1N1) pandemic, the real-time laboratory-based influenza surveillance system, the Bangkok Dusit Medical Services Surveillance System (BDMS-SS), was developed in 2010 by the Bangkok Health Research Center (BHRC). The primary objective of the BDMS-SS is to alert relevant stakeholders on the incidence trends of the influenza virus. Type-specific results along with patient demographic and geographic information were available to physicians and uploaded for public health awareness within 24 hours after patient nasopharyngeal swab was collected. This system advances early warning and supports better decision making during infectious disease events.2 The BDMS-SS operates all year round collecting results of all routinely tested respiratory clinical samples from participating hospitals from the largest group of private hospitals in Thailand.Methods: The BDMS has a comprehensive network of laboratory, epidemiologic, and early warning surveillance systems which represents the largest body of information from private hospitals across Thailand. Hospitals and clinical laboratories have deployed automatic reporting mechanisms since 2010 and have effectively improved timeliness of laboratory data reporting. In April 2017, the capacity of near real-time influenza surveillance in BDMS was found to have a demonstrated and sustainable capability.Results: From October 2010 to April 2017, a total of 482,789 subjects were tested and 86,110 (17.8%) cases of influenza were identified. Of those who tested positive for influenza they were aged 65 years old (3.7%). Approximately 50% of subjects were male and female. Of these, 40,552 (47.0%) were influenza type B, 31,412 (36.4%) were influenza A unspecified subtype, 6,181 (7.2%) were influenza A H1N1, 4,001 (4.6%) were influenza A H3N2, 3,835 (4.4%) were influenza A seasonal and 196 (0.4%) were respiratory syncytial virus (RSV).The number of influenza-positive specimens reported by the real-time influenza surveillance system were from week 40, 2015 to week 39, 2016. A total of 117,867 subjects were tested and 17,572 (14.91%) cases tested positive for the influenza virus (Figure 1). Based on the long-term monitoring of collected information, this system can delineate the epidemiologic pattern of circulating viruses in near real-time manner, which clearly shows annual peaks in winter dominated by influenza subtype B in 2015-1016 season. This surveillance system helps to provide near real-time reporting, enabling rapid implementation of control measures for influenza outbreaks.Conclusions: This surveillance system was the first real-time, daily reporting surveillance system to report on the largest data base of private hospitals in Thailand and provides timely reports and feedback to all stakeholders. It provides an important supplement to the routine influenza surveillance system in Thailand. This illustrates a high level of awareness and willingness among the BDMS hospital network to report emerging infectious diseases, and highlights the robust and sensitive nature of BDMS’s surveillance system. This system demonstrates the flexibility of the surveillance systems in BDMS to evaluate to emerging infectious disease and major communicable diseases. Through participation in the Thailand influenza surveillance network, BDMS can more actively collaborate with national counterparts and use its expertise to strengthen global and regional surveillance capacity in Southeast Asia, in order to secure advances for a world safe and secure from infectious disease. Furthermore, this system can be quickly adapted and used to monitor future influenzas pandemics and other major outbreaks of respiratory infectious disease, including novel pathogens.

Three challenges of supporting health research in a private hospital setting were identified as (i) weak evaluation of research projects, (ii) weak connection between research and implementation and (iii) misunderstanding on the concepts and processes of research. This paper describes briefly experiences of the Bangkok Health Research Center and its strategies to meet these challenges.

BACKGROUND: Analysis of HIV transmission rates has provided insight into the impacts of HIV-related prevention programming and policies in the United States by providing timely information beyond incidence or prevalence alone. The purpose of this analysis is to use transmission rates to assess past prevention efforts and explore trends of the epidemic in subpopulations within Thailand. METHODS: Asian Epidemic Model HIV incidence and prevalence were used to calculate transmission rates over time nationally and among high-risk populations. RESULTS: A national HIV/AIDS program implemented in Thailand in the 1990s that targeted sex workers and the general population was correlated with a decrease in new cases despite high prevalence. The turning point of the epidemic was in 1991 when the national transmission rate was 32%. By the late 1990s the rate dropped to less than 4%. All subpopulations experienced a rate decline; however sex workers still experienced higher transmission rates. CONCLUSIONS: The declining trend in HIV transmission rates despite ever-growing prevalence indicates prevention success correlated with the national HIV/AIDS program. Data from subgroup analyses provide stronger evidence of prevention success than incidence alone as this measure demonstrates the effect of efforts and accounts for the burden of disease in the population.

Background: the major purpose of health and social policy in old age is to increase quality of life of elderly people. In many demographically developing countries, life expectancy is increasing very rapidly, but little information is available on survival free of disability. Objectives: to determine prevalence and severity of disability among the elderly population and to compare disability-free life expectancy and self-care life expectancy among different age groups and between men and women. Design: a cross-sectional multi-stage random sample survey and routine life tables for Thailand. Setting: national population of Thailand. Subjects: 4,048 elderly subjects aged 60q years. Results: prevalence rates (95% CI) of long-term disability and dependency in self-care activities of daily living were 19% (95% CI 17.8, 20.2) and 6.9% (6.1, 7.7) respectively. Rates of disabilities increased with age and women were more disabled than men. The life expectancy and disability-free life expectancy at age 60 for men were 20.3 years and 16.4 years, and for women were 23.9 years and 18.2 years respectively. Self-care life expectancies at age 60, calculated from the prevalence of needing help with basic self-care activities, were 18.6 years and 21.3 years for men and women respectively. Women spent proportionately more of their longer life expectancy in a disabled state than men. Men and women can, respectively, expect that 19% and 24% of their life expectancy at age 60 will be spent in a disabled state, but may expect only about 10% of their life expectancy to be spent unable to manage basic self-care activities of daily living. Conclusion: long-term disability is common in old age, affecting a quarter of people over 60 years. However, selfcare problems are much less common and suggest that the social and health care consequences of demographic transitions are over-estimated by use of simple questions about limiting long-standing disability. Self-care life expectancy provides a useful monitoring tool for censuses and national disability surveys.

Objective: To assess the efficacy and tolerability of a triple nucleoside reverse transcriptase inhibitor combination of zidovudine, lamivudine, and didanosine therapy. Design: A randomized open-label trial. Patients: Antiretroviral-naive HIV-infected patients with CD4 + cell counts of 100 to 500 cells/μl. Methods: A total of 106 patients were randomly assigned to 300 mg of zidovudine (200 mg for body weight

To evaluate the safety and efficacy of four different regimens of didanosine (ddI) + stavudine (d4T) in HIV-infected Thais. Prospective, open-label, randomized study. Patients were randomized to four regimens of high and low doses of ddI and d4T or to ddI alone. D4T was added to the ddI-alone arm after week 24. The duration of study was 48 weeks. Seventy-eight patients were randomized (mean CD4 cell count, 255 x 10(6)/l; mean plasma HIV-1 RNA; 4.3 log10 copies/ml). In the intent-to-treat analysis, 78% of patients in the pooled combination arms and 20% of the patients in the ddI alone arm (to which d4T was added after 24 weeks) showed plasma HIV-1 RNA < 500 copies/ml at week 24 (P < 0.001), and 59% versus 53% at week 48, respectively. In addition, the proportion of patients with < 50 HIV-1 RNA copies/ml was 13% versus 7% at week 24 (P = 0.5) and 17% versus 20% at week 48 respectively. At week 24, median CD4 cell count increases from baseline were 101 x 10(6)/l in the pooled combination versus 76 x 10(6)/l in the ddI alone arm (P = 0.78). Logistic regression modeling suggested a correlation between receiving high dose ddI and achieving HIV-1 RNA < 500 copies/ml at week 48 (P = 0.07). The d4T/ddI combination was superior to ddI alone in producing HIV-1 viral suppression. At week 48, > 60% of patients treated with this combination reached HIV-1 RNA levels < 500 copies/ml. Receiving high dose ddI but not d4T may correlate with a better viral suppression

Initial research on the genetic variability of human immunodeficiency virus (HIV)-1 has indicated that HIV-1 envelope subtype B is dominant in Western countries where homosexuality and injecting drug use are the major risk factors while env subtypes A C D and E predominate in Africa and Asia where most transmission is heterosexual. Data from South Africa and Thailand suggest that due to limited mixing of population subgroups largely independent HIV epidemics caused by different genotypic subgroups may co-exist in a given geographic area. On the other hand the possibility that HIV-1 subtypes differ in transmission efficiency by exposure mode also has some support. For example subtypes E and C appear to be better adapted to penile-vaginal transmission while subtypes B E and C may be transmitted efficiently through blood. Factors such as sexual mixing patterns (e.g. commercial sex work) and the prevalence of sexually transmitted diseases must also be considered when examining HIV-1 subtype transmission differences. The use of new assays that allow for the accurate measurement of viral levels in plasma semen and genital secretions should complement epidemiologic estimates of transmission efficiency for various HIV-1 subtypes.

Only a small minority of people in the world infected with HIV will receive the benefits of the current advances in medical treatment. Planning is required to ensure that each country provides the best possible care allowed by its health resources. Relatively small amounts of money, if well spent, can go a long way towards reducing suffering and assisting death with dignity.

To describe the prevalence of overweight and obesity and examine their relationship with socio-demographic factors in Thai adults. Using data from a cross-sectional survey, the National Health Examination Survey II (NHESII), the authors examined the prevalence of overweight (BMIor = 25 kg/m2) and obesity (BMIor = 30 kg/m2) in 3,220 Thai adults aged 20-59 yr. Univariate analyses and Logistic regression models were used to examine the association of overweight and obesity with socio-demographic and behavioral risk factors. The overall age-adjusted prevalence of overweight and obesity were 28.3% and 6.8% respectively, with a higher prevalence for women than for men (overweight: 33.9% vs 19.2% and obesity: 8.8% vs 3.5%). The prevalence of overweight and obesity was greater among older compared to younger people and among residents of urban (34.8% and 9.9%) compared to rural areas (26.4% and 5.9%). The prevalence of overweight and obesity varied by region in line with the level of economic development--Bangkok, Central, North, South and North-East. By using logistic regression analysis, overweight was associated with a number of characteristics as follows: age (per ten years increase) with adjusted Odds Ratio (OR) of 1.3; women 1.4; married 2.2; being a current smoker 0.4, and living in Bangkok and the central region 1.6 (compare to North-East). There was no clear difference in prevalence of overweight and obesity among education levels and type of occupation after controlling for other covariates. In conclusion, women of middle age, married, and living in Bangkok and the Central region, are at greater risk of overweight and obesity. Without effective lifestyle modification programs to curb these physiologic risk factors at population level, it is likely that related disease burden will ensue. Public health surveillance and intervention to modify the risk factors of excessive weight should be implemented.

In order to determine which diseases and health problems were most strongly associated with long-term disability among the Thai elderly and to determine their public health priority, a national cross-sectional multistage random sampling survey was conducted in 1997. Four thousand and forty-eight Thai older persons aged 60 years and over were recruited and interviewed by trained interviewers. Overall, 769 (19%) people reported having a long-term disability. Participants with long-term disability (LD) reported having between one and 21 long-term diseases or health problems. Eighteen of these problems were independently associated with LD in logistic regression analysis. Nearly half of the cases with LD (46.4%) suffered from two or more health problems. The odds of LD increased with the number of problems suffered. The problems contributing most to the population burden of disease as assessed by population attributable risk fractions were hemiparesis, arthritis, accidents (unintentional injuries), blindness and other eye diseases, kyphosis, weakness of limbs, deafness, and hypertension. This ranking of public health priority differs from conventional approaches using mortality statistics and disability adjusted life years (DALYs). In conclusion, national disability surveys provide a valuable means of assessing the population burden of disability and determining the underlying causes of disability. These methods provide a direct assessment of disability prevalence and disease priorities for rapidly ageing transitional countries where death certification may be incomplete or inaccurate.

The rapid growth of the HIV/AIDS epidemic in Thailand began in the late 1980s, as in many other countries in Asia, but with a subsequently more rapid upsurge in HIV prevalence than in the other countries. Some factors provided fertile ground for HIV transmission in Thailand, including an extensive sex industry that drew its male clientele from across the socioeconomic spectrum. This coincided with high levels of several other sexually transmissible infections (STI), and the widespread practice of injecting illicit drugs. These risk factors have been exacerbated by a certain societal reticence to publicly acknowledge the ubiquity of sexual and drug use practices that represent potential pathways for HIV transmission.

To determine the relationship between television viewing and obesity among Thai children.A one-stage cross-sectional national survey.National communities in Thailand.Four thousand one hundred and ninety-seven children aged 6 to 12 years old.By using the new national growth reference as a normative data, 262 (6.2%) children in this survey were obese. According to the caregivers, 62 per cent of children watched television I to 3 hours per day. Children who spent more than 3 hours per day watching television were more likely to be obese than the children who watched television less with the odd ratio of 1.8 (95% confidence interval = 1.2-2.8).With a one-stage design for determining the association between television viewing and childhood obesity, Thai school age children who watched television more than 3 hours per day were more likely to be obese with statistical significance.

Objectives To evaluate the impact of the modified ACTG 076 zidovudine regimen on the risk for vertical HIV transmission. Design Observational retrospective evaluation of a prospective cohort. Setting Thai Red Cross zidovudine donation program to reduce vertical HIV transmission. Patients HIV-infected Thai women and their offspring. Intervention The modified regimen consisted of 500 mg zidovudine daily during pregnancy and 300 mg zidovudine every 3 h during labor, taken orally, and 2 mg/kg zidovudine syrup four times daily for 6 weeks to infants. Main outcome measures Only infants with at least 1 HIV DNA polymerase chain reaction (PCR) result at age > or = 4 weeks were included. HIV infection was defined by having at least one positive PCR at age > or = 4 weeks. The transmission rate was calculated. Characteristics of women who did and did not transmit HIV to infants were compared. Results A total of 2891 women and their infants participated in the program and 726 infants of 719 women were included in the analysis. Forty-three infants were infected. The overall transmission rate was 6.0% (95% confidence interval, 4.4-8.0). There were no differences in maternal characteristics between transmitters and non-transmitters. The transmission rate in women who started zidovudine before 30 weeks' gestation was not significantly different from that in women who started zidovudine at or after 30 weeks' gestation: 5.7 versus 3.3%, respectively. Conclusions This modified zidovudine regimen is effective in reducing vertical transmission in a country with predominant subtype E infection. A donation program for preventing vertical HIV transmission can be implemented in developing countries, as in Thailand.

The aim was to assess the immunological and virological effects safety profile and feasibility of subcutaneous interleukin-2 (scIL-2) therapy in an HIV-infected Thai population. 72 patients with baseline CD4 cell count of 350000000/l or higher and no history of opportunistic infection were randomized to receive antiretroviral therapy plus scIL-2 (scIL-2 group) or antiretroviral therapy alone (control group). scIL-2 was administered at one of three doses for at least 24 weeks. The main measure of treatment efficacy was change in CD4 cell count. The time-weighted mean change in CD4 cell count from baseline to week 24 was +252000000/l for the scIL-2 group compared with +42000000/l for the control group (P < 0.0001). Changes in plasma HIV ribonucleic acid were not significantly different between the groups over the same time period: there was a 0.83 log10 copies/ml decrease for the scIL-2 group and a 0.70 log copies/ml decrease for the control group (P = 0.362). This study provides the most extensive experience of scIL-2 therapy in HIV-1 infected women and Asians and demonstrates the immunological efficacy tolerability and feasibility of scIL-2 in this population. Data from this study were instrumental in guiding the selection of the scIL-2 dosing regimen for on-going phase III trials. (authors)

We examined the risk factors for heterosexual transmission of HIV in a case-control study of couples in Thailand. 90 HIV-positive men and their regular sex partners were enrolled at the immune clinic, Chulalongkorn Hospital, where 92% of male index cases had HIV-1 serotype A (subtype E). Most index cases had acquired HIV through sexual intercourse. 95 couples were enrolled at 15 detoxification clinics, where 79% of them had HIV-1 serotype B (subtype B). Most men had acquired HIV through injecting drug use (IDU).A case control study was conducted during February 1992-April 1993 in Bangkok, Thailand, among 62 couples of which both partners were HIV seropositive (concordant couples [cases]) and 46 couples of which the man was HIV seropositive and the woman was HIV seronegative. The subjects were patients in the Immune Clinic in Chulalongkorn Hospital and in 15 drug detoxification (IDU) clinics. Couples in the immune clinic were more likely to be HIV seroconcordant than those in the IDU clinics (69% vs. 48%; 67% vs. 27%, after excluding females who were intravenous [IV] drug users; p 0.01). HIV-1 serotype B (subtype B) was more common among men in the IDU clinics while HIV-1 serotype A (subtype E) (79%) was more common among men in the immune clinic (92%). Seroconcordance was much more common when HIV-1 was of serotype A than when it was of serotype B (70% vs. 52%; odds ratio [OR] = 2.1; p 0.05). Further, when the researchers did not include couples of which the woman was an IV drug user, the difference in concordance was even greater (70% vs. 26%, OR = 6.8; p 0.01). These differences in concordance suggest that HIV-1 serotype A may be more efficiently transmitted than HIV-1 serotype B. The multivariate logistic regression analysis showed that independent risk factors of HIV seroconcordance were HIV-1 serotype A of male partners (adjusted OR = 3.1) and history of IV drug use in female partners (AOR = 4.8). HIV-1 subtype E may be linked to a higher risk of heterosexual transmission than subtype B. If so, the predominance of HIV-1 subtype E in Thailand could explain the rapid spread of HIV infection in Thailand.

An outbreak of anthrax occurred among 14 persons exposed to the meat of two water buffalo which had died from anthrax, in two neighbouring villages in the northeastern region of Thailand. All but one case had typical eschars or blisters. Three had eaten raw meat; one of them died from gastric anthrax with severe haematemesis. All the others were successfully treated with penicillin. The incubation period varied between two and 11 days. Sporadic outbreaks of human and animal anthrax still occur in Southeast Asia.

Trading blocs realize the strategic importance of and threats from emerging infections, particularly those related to travel and food. Like the European Union, the Asia Pacific Economic Cooperation (APEC) is undertaking an initiative in emerging infections. The APEC Emerging Infections Network project builds on an existing Internet-based educational network (APEC EduNet), created to help link APEC “study centers” at designated universities. Use of collaborative tools, such as e-mail and the World Wide Web, helps bridge the broad geographic expanse and diversity of APEC economies, permitting scientists and policy makers to share information and more effectively combat emerging infectious disease through surveillance, prevention, research, and control measures. In the project’s first year, staff made site visits to Thailand, Indonesia, the Philippines, and Canada, and compiled information regarding Internet access in these selected economies. Multidrug-resistant tuberculosis (MDRTB) was selected as a disease priority by the partner economies. Accurate, prospective surveillance data on MDRTB are not generally available. Information sharing by e-mail and automated email lists has been successful, and feedback suggests these strategies will become increasingly useful. The Emerging Infections Network (EINet) Web site includes project information, surveillance data, policy discussion, prevention guidelines, and distance learning resources about emerging infections. Human networking is as important as technology-based networking in addressing emerging infections. Technology is adequate to support communications if a comprehensive telecommunications strategy is used. APEC, unlike the European Union, does not have the treaty basis to support this intercountry collaboration, so memoranda of understanding are needed to facilitate sustainable surveillance information flow and scientific cooperation. Numerous member economies are eager to be included in project activities. In the second year the project is expanding both in terms of breadth of information and geography of economies.