Epidemic Of Tuberculosis In Thailand

[sriracha john]

TB epidemic in Thailand

Thailand has the 17th highest incidence of tuberculosis in the world

Bangkok Metropolitan Administration Health Department deputy director Dr Chanchai Kumphong said 90,000 people were infected with tuberculosis every year. About 15,000, or 16.5 per cent, are in Bangkok.

At least 60 per cent of Bangkok infections involve people younger than 45. Most live in crowded areas, he said.

"There is a high risk of passing the disease to others because tuberculosis symptoms do not appear immediately," Chanchai said.

National Health Security Office senior official Dr Chuchai Sornchamni said random checks of crowded places like shopping centres, department stores and fresh markets found one tuberculosis sufferer in every 500 people.

Chanchai said there was a 98 per cent chance of full recovery if treated.

"If you cough for two weeks, start losing weight and have a slight fever in the evenings, see a doctor," Chanchai added.

- The Nation

[Prakanong]

"Chanchai said there was a 98 per cent chance of full recovery if treated."

Is it not a long and expensive treatment though?

Hopefully there will be a new TB vaccine in the near term which is effective against the new strains of drug resisitant TB.

There was a thread in the health section about TB and just the anecdotal evidence there showed the extent of the problem.

I personally know of two cases in Thailand - both died. One Thai girl a long term partner of a friend and a Farang guy. I know the girl did not have HIV/AIDS but the jury is out on the guy.

Edited May 22, 2007 by Prakanong

[Tompa]

My girlfriend caught TB about 2 years ago in Chanthaburi. Luckily she didn’t get too sick, but it took forever to cure it. She had to eat medication for well over 6 months. We were very lucky though as she left it for a long time before I could finally drag her to the doctor for a check up.

I can’t remember how expensive the medication was, but I think it ended up somewhere between 10-20000 Baht, still a small price to pay for your life!

Tompa,

[Prakanong]

"I can’t remember how expensive the medication was, but I think it ended up somewhere between 10-20000 Baht, still a small price to pay for your life! "

Am I correct to assume that was for the total course of treatment over 6 months?

The guy I knew in Bangkok had been quoting a much higher price than that. Then he could not afford it all the time so his compliance was way down leading to drug resistance.

I think he might have been on them for 18 months before he died but as I say his compliance was poor so the story goes.

There is also the factor he was pumping other guys for money to buy medication.

[Tompa]

Yes, the 10-20000 was for the whole treatment (it might have been slightly more than this as my memory is not 100% clear). We went to a hospital in Chanthaburi and she had to come back for regular check up's during the treatment time.

Tompa,

[sriracha john]

Witnessed several deaths from advanced, untreated TB while volunteering at a Philippine TB ward in the late 1970's. All of them bled to death by coughing and vomiting up copious amounts of blood which led to cardiac failure. Not a pretty picture.

According to the World Health Organization, "tuberculosis kills about 1.7 million people worldwide, mostly in developing countries."

Lots of problems today with drug-resistant TB.

While the germ responsible, mycobacterium tuberculosis, looks rather innocuous...

its devastating effect on major organs like lungs...

and kidneys...

can result in an agonizing, excruciating, and horrific death...

[Prakanong]

Some good info from WHO on TB

http://www.who.int/tb/en/

It explains exactly how the guy I knew of in Bangkok would have developed the drug resistance strain - non-compliance or mis-use.

This was a guy who would have lost about 40+ Kg fwhen i saw him last.

[Jai Dee]

NHSO to provide full medical services to TB patients in BKK

The National Health Security Office (NHSO) cooperates with the Bangkok Metropolitan Administration (BMA) in conducting a program to provide full medical services for tuberculosis (TB) patients after the World Health Organization (WTO) has reported that 5,000 new TB patients occur each day or one in every 10 seconds.

Director of NHSO’s disease management office, Md.Chuchai Sornchamni (ชูชัย ศรชำนิ) informs that NHSO and BMA will also implement urgent and resolute measures to prevent tuberculosis especially in crowded places, including shopping malls and markets. He says one in every 500 persons in Bangkok have been contracted tuberculosis.

The director adds that NHSO and BMA will search for new TB patients and assign medical assistants to oversee their drug intake for the next consecutive six months.

TB patients in Bangkok are encouraged to contact NHSO at 085-123-1126 to participate in the program which will expand to other provinces in the near future.

Source: Thai National News Bureau Public Relations Department - 22 May 2007

[Scott]

But surely there must be a big pharmaceutical company that they can shake down. We can't expect the gov't to take any responsibility for this; it must be the fault of some western gov't!

[Ijustwannateach]

One in 500?!?

[Prakanong]

One in 500?!?

I think one in three carry the bacteria but like you 1 in 500 with the actual disease I find hard to believe.

Where is an epidemiologist studying the disease burden of TB in Bangkok when you need one?

What does this mean then?

"The director adds that NHSO and BMA will search for new TB patients and assign medical assistants to oversee their drug intake for the next consecutive six months."

Are these medical assistants going to be with these patients 24 hours a day or just turn up at the 3 or 4 times a day they are to take their medicine to ensure compliance?

Or are they ust going to be asked on their regular checkup's if they have been compliant?

Some countries including the USA can lock you up in a TB ward to ensure compliance and reduce the risk to public health.

Edited May 22, 2007 by Prakanong

[sriracha john]

One in 500?!?

I think one in three carry the bacteria but like you 1 in 500 with the actual disease I find hard to believe.

Where is an epidemiologist studying the disease burden of TB in Bangkok when you need one?

According to WHO statistics for Thailand (2004) the prevalence is 208 per 100,000 population = 1 in 481.

Mortality rate is 19 per 100,000 population.

http://www.who.int/tb/publications/global_...006/pdf/tha.pdf

[Prakanong]

One in 500?!?

I think one in three carry the bacteria but like you 1 in 500 with the actual disease I find hard to believe.

Where is an epidemiologist studying the disease burden of TB in Bangkok when you need one?

According to WHO statistics for Thailand (2004) the prevalence is 208 per 100,000 population = 1 in 481.

Mortality rate is 19 per 100,000 population.

http://www.who.int/tb/publications/global_...006/pdf/tha.pdf

Thanks for that - it just seems so high when you hear the figure like 1 in 500 or more accurately 1 in 481.

So how many people a day are we coming into contact with TB?

I know the demographics ie social group etc makes a lot of difference and the longer you have prolonged contact the higher the chances of getting it but even so!!!

[Dakhar]

The meds are not that well tolerated...

[Ijustwannateach]

Could there be some leeway in what "contracted" means? Does this 1 in 500 include some sort of dormant group who have antibodies but no symptoms?

From what little I know when you're exposed to TB whether or not you develop the full disease depends a lot on your current immune state- if I'm not mistaken, it's not a particularly "easy" disease to catch. Or is this new strain a different story?

[Prakanong]

Could there be some leeway in what "contracted" means? Does this 1 in 500 include some sort of dormant group who have antibodies but no symptoms?

From what little I know when you're exposed to TB whether or not you develop the full disease depends a lot on your current immune state- if I'm not mistaken, it's not a particularly "easy" disease to catch. Or is this new strain a different story?

I think the figures for those with dormant bacteria are 1 in 3.

I was also of the view that its not a particularly easy disease to catch - anecdotal evidence from here and elsewhere would suggest that with people close to patients not contracting the disease.

If I have read correctly as well there is only a certain period in the active cycle of the disease when its contagious - anyone?

[sriracha john]

Please refer to the latent vs active TB sections of:

http://www.cdc.gov/tb/faqs/qa_introduction.htm#Intro4

which should explain most of your questions, IJWT and Prakanong.

I'm off to see if I can find what the diagnostic criteria the WHO uses to determine "prevalence" of TB...

[sriracha john]

WHO definitions:

Incidence - new cases arising in given period, typically in one year

Prevalence - the number of cases which exist in the population at a given point in time

Left untreated, each person with active TB disease will infect on average between 10 and 15 people every year. But people infected with TB bacilli will not necessarily become sick with the disease. The immune system "walls off" the TB bacilli which, protected by a thick waxy coat, can lie dormant for years. When someone's immune system is weakened, the chances of becoming sick are greater.

- Someone in the world is newly infected with TB bacilli every second.

- Overall, one-third of the world's population is currently infected with the TB bacillus.

http://www.who.int/mediacentre/factsheets/fs104/en/

--------------

Couldn't find any definitive statement regarding which type the "prevalence" refers to, but given the figure of approximately 33% of people have become infected with TB bacillus...

I would conclude that the 1 in 481 amount listed above in regards to its prevalence in Thailand as those with active TB.

[Mai Krap]

Basically nobody here cares anyway, How many times have you ever heard of a Thai getting medical tests unless they were in the hospital about to die? Back in the day I would take buses all over Thailand. There always seems to be that one person who cannot stop coughing on the bus and on occasion I was lucky enough for them to sit right behind and cough on me all the way to point B. I no longer take buses and that is the main reason outside the fact they are dangerous in general. I often wonder how many of these folks had TB? Its not like any food worker here is tested for anything or even the food is checked for anything for that matter.

Another big problem in Thailand is leprosy. It is far more common than one would think.

Edited May 22, 2007 by Mai Krap

[Ijustwannateach]

Please refer to the latent vs active TB sections of:

http://www.cdc.gov/tb/faqs/qa_introduction.htm#Intro4

which should explain most of your questions, IJWT and Prakanong.

I'm off to see if I can find what the diagnostic criteria the WHO uses to determine "prevalence" of TB...

Thanks, SRJ..... have a feeling next time I stop by the doc I'll get that skin test, just in case...

[Prakanong]

Please refer to the latent vs active TB sections of:

http://www.cdc.gov/tb/faqs/qa_introduction.htm#Intro4

which should explain most of your questions, IJWT and Prakanong.

I'm off to see if I can find what the diagnostic criteria the WHO uses to determine "prevalence" of TB...

Thanks, SRJ..... have a feeling next time I stop by the doc I'll get that skin test, just in case...

Yearly chest x-rays are a good idea too - they are always part of my health screening plus I was told I needed clearance on TB and HIV for my EP in Singapore.

Strange thing though is they just had me sign to say I was clear - some colleagues had to show certificates. I think its where you come from that they determine if they want evidence or self-cert - crazy these days.

[DrFisher]

TB is on the rise I read the local paper from my home town (Allentown, Pennsylvania) and they found a few cases of TB in the local high school. Old diseases have a way of coming back years latter I know the USA has some concern about small pox and German measles I think my generation was the last immunized for these two and they are talking about starting the vaccine for school aged children again.

[Prakanong]

TB is on the rise I read the local paper from my home town (Allentown, Pennsylvania) and they found a few cases of TB in the local high school. Old diseases have a way of coming back years latter I know the USA has some concern about small pox and German measles I think my generation was the last immunized for these two and they are talking about starting the vaccine for school aged children again.

Smallpox - I do not think they are vaccinating for that again nor will be unless you work with it in a lab. I am pretty sure according to WHO its officially eradicated except in the lab.

Polio nearly was classified as such but still a way to go.

German Measles - known as Rubella - already vaccinated against - MMR (Mump Measles Rubella) jab but you can get these individually too - I will try to hunt out the vaccination schedule for that if you like

Edited May 22, 2007 by Prakanong

[sriracha john]

Please refer to the latent vs active TB sections of:

http://www.cdc.gov/tb/faqs/qa_introduction.htm#Intro4

which should explain most of your questions, IJWT and Prakanong.

I'm off to see if I can find what the diagnostic criteria the WHO uses to determine "prevalence" of TB...

Thanks, SRJ..... have a feeling next time I stop by the doc I'll get that skin test, just in case...

You're welcome... and an annual skin test is a good idea. It's quick, benign, and painless and I imagine very inexpensive here. Unsurprisingly, I converted (had a reaction indicating exposure to the tuberculosis bacteria) years ago.

As for a chest x-ray, I would skip that unless there is a specific medical indication for getting one done (or an absolute requirement to having one for work considerations). It's a fairly high dose of ionizing radiation which is always best to avoid and really unjustifiable unless one is symptomatic or they have a positive skin test .

[Prakanong]

"Unsurprisingly, I converted (had a reaction indicating exposure to the tuberculosis bacteria) years ago."

I did too as a kid and that is why I never needed the BCG - myself and my Mam had to go for chest x-rays though - this was back in the early 70's

[buriramboy]

i actualy thought i had TB as had been coughing up bright green mucas for over a week, but put it down to my excessive smoking combined with a cold, however Sunday and Monday night i had basicaly no sleep due to not being able to breathe when lying down, then having a serious coughing fit to clear my throat, then gasping for air again. Anyway was reading this thread yesterday and then did a bit of my own research on TB and thought <deleted> these are the symptoms i have, so dragged my sorry ass down to PIH about 5pm yesterday had a chest x-ray and thankfully just bad brochitus (spelling), they pumped some anti-biotics into me and your usual 4 types of different tablets they give you and had a good nights sleep last night, while still coughing at least i can breathe now and have not had a ciggy since sunday. While my brochitus is still bad and painful, it still feels like i've won the lottery when i was seriously expecting to have been diagnosed with TB yesterday.

[Prakanong]

Reading a lot of symptoms leads a lot of people to beleive they have the illness concerned ;-)

I get bronchitis from my time in the coal mine - if I spend any time in Bangkok it comes on with the associated phlegm.

A few days at the beach cures it and I do not get it anywhere else much unless I have been partying every night for more than a few days - that seems to bring it on??????

[Ijustwannateach]

Please refer to the latent vs active TB sections of:

http://www.cdc.gov/tb/faqs/qa_introduction.htm#Intro4

which should explain most of your questions, IJWT and Prakanong.

I'm off to see if I can find what the diagnostic criteria the WHO uses to determine "prevalence" of TB...

Thanks, SRJ..... have a feeling next time I stop by the doc I'll get that skin test, just in case...

You're welcome... and an annual skin test is a good idea. It's quick, benign, and painless and I imagine very inexpensive here. Unsurprisingly, I converted (had a reaction indicating exposure to the tuberculosis bacteria) years ago.

As for a chest x-ray, I would skip that unless there is a specific medical indication for getting one done (or an absolute requirement to having one for work considerations). It's a fairly high dose of ionizing radiation which is always best to avoid and really unjustifiable unless one is symptomatic or they have a positive skin test .

Yes- and that X-ray is really only advisable for ADULT people or those who are symptomatic in other ways- it has been a point of contention between foreign teachers and Asian schools for many years that the annual chest X-ray that many students are required to have (and teachers as well) is an unnecessary and even dangerous precaution- ALL Japanese students get one (considering the number of years in school, this is a lot of unnecessary radiation) and at some of the ritzier schools here they give one.

SRJ, the link you posted indicated that those who had seroconverted could take medicines to "clean out" their system of the bacterial traces- did you do that, or is it unnecessary?

"S"

[sriracha john]

Please refer to the latent vs active TB sections of:

http://www.cdc.gov/tb/faqs/qa_introduction.htm#Intro4

which should explain most of your questions, IJWT and Prakanong.

I'm off to see if I can find what the diagnostic criteria the WHO uses to determine "prevalence" of TB...

Thanks, SRJ..... have a feeling next time I stop by the doc I'll get that skin test, just in case...

You're welcome... and an annual skin test is a good idea. It's quick, benign, and painless and I imagine very inexpensive here. Unsurprisingly, I converted (had a reaction indicating exposure to the tuberculosis bacteria) years ago.

As for a chest x-ray, I would skip that unless there is a specific medical indication for getting one done (or an absolute requirement to having one for work considerations). It's a fairly high dose of ionizing radiation which is always best to avoid and really unjustifiable unless one is symptomatic or they have a positive skin test .

Yes- and that X-ray is really only advisable for ADULT people or those who are symptomatic in other ways- it has been a point of contention between foreign teachers and Asian schools for many years that the annual chest X-ray that many students are required to have (and teachers as well) is an unnecessary and even dangerous precaution- ALL Japanese students get one (considering the number of years in school, this is a lot of unnecessary radiation) and at some of the ritzier schools here they give one.

SRJ, the link you posted indicated that those who had seroconverted could take medicines to "clean out" their system of the bacterial traces- did you do that, or is it unnecessary?

"S"

Yes, I did. When I reacted, I underwent several additional blood tests, X-ray, etc. and when everything else came out negative, I took INH daily for six months. I would say it IS necessary as a reasonable precaution against the development of active TB.

A simple, but acceptably accurate explanation of that is here:

http://answers.yahoo.com/question/index?qi...13121449AAxDr2t

I was unaware of the requirement for annual chest X-rays for some students and teachers. Ionizing radiation is especially detrimental to children due to their rapid cell growth. That's something that's been known for decades... and rather surprising that such an antiquated screening system without justification is still being used. It's akin to the old shoe shops that used to X-ray people's feet in shoes to ensure a good fit.

[sriracha john]

UPDATE.... with bad news

13 cases of 'super TB' strain found

Thailand has 13 confirmed cases of the dangerous and highly drug-resistant form of tuberculosis, according to the chairman of the Drug Resistant TB Research Fund.

Dr Manoon Leechawengwong said yesterday the fund, under the patronage of the Siriraj Foundation, started research into drug-resistant forms of TB in 2001 and had found 13 cases identified as XDR-TB.

This definition means the TB strain is extremely drug-resistant, especially to first- and second-line drugs. Treatment options for patients with XDR-TB are severely limited.

However, Dr Mongkol na Songkhla, the public health minister, said he had not yet been informed of the XDR cases here. He claimed the ministry monitored drug-resistant forms of TB, but only multi-drug-resistant MDR had been found.

The difference between patients with MDR-TB and XDR-TB is that the first group has more treatment options than the latter. MDR-TB is resistant only to first-line drugs.

XDR-TB recently became world news after a law, unused for 44 years, was invoked to isolate a man in the United States last month. Currently there is no treatment for XDR-TB.

Manoon's disclosure about the confirmed XDR-TB cases contradicted information from the ministry. Last week, Dr Tawat Suntra-jarn, head of the Disease Control Department, insisted there were no cases of Thais infected with XDR-TB.

But Manoon claimed the Health Ministry did not pay enough attention to monitoring and preventing the spread of drug-resistant TB.

"We have to speak the truth and look for a way to prevent the spread of the disease," he said.

In order to identify drug-resistant forms of TB, Manoon said hospitals nationwide had cooperated by sending TB germ samples from patients.

While there are about 80,000 new TB cases each year, he had only been sent 15,000 samples over five years of his research project. Besides the 13 cases of XDR-TB, his lab tests also found about 500 cases of MDR-TB.

Manoon wants the ministry to be more proactive in controlling the spread of TB, especially the strains resistant to drugs. He suggested it seriously examine TB cases to identify XDR and MDR cases.

"If possible, the government should have the power to restrict the movement of those infected with drug-resistant forms of TB - to reduce the chance of them spreading the disease."

He said the main concern was how the country prevented the spread of the disease.

- The Nation