The second confirmed case of Mpox (Monkeypox) in Nakhon Si Thammarat, Thailand, October 2023

Abstract

Background: On 6^th October 2023, Thung Song District Joint Investigation Team (JIT) was notified by the male medicine unit of a general hospital in Nakhon Si Thammarat, Thailand, about a confirmed Mpox case. The patient had traveled from Bangkok and was admitted to a hospital in Nakhon Si Thammarat. The investigation team was conducted to confirm the diagnosis, determine risk factors, and recommend appropriate preventive and control measures. Their investigation involved reviewing the patient’s medical record and case report of Mpox from Nakhon Si Thammarat Provincial Public Health Office, including contact tracing, active case finding, and identifying source of infection. Laboratory investigation was performed by the real-time polymerase chain reaction (RT–PCR) to determine of Mpox virus and viral clade detection by genome sequencing. In addition, an environmental investigation, and the Mpox surveillance system in Nakhon Si Thammarat province were carried out.

Results: One confirmed case of Mpox was identified. A 23–years old of Thai male with sexual diversity, and HIV infection, who traveled from Bangkok to his hometown in Thung Song district, Nakhon Si Thammarat province on 1 October 2023. He developed of itchy skin rashes on his face, arms, legs, and crusted on pustules at the buttock and anogenital area on 28 August 2023. For laboratory diagnosis, both specimens from the lesion crusts of pustule at glans penis, and oropharyngeal swab were positive for the clade II (West African clade) of the Mpox virus. To have attended events at amusement venues and living in the Mpox outbreak area were determined as a source of transmission, while unsafe sex with strangers as a possible risk. All Case's close contacts—16 high-risk and 8 low-risk—tested negative for Mpox infection. This case defined as a local transmission, and the Mpox surveillance system in Nakhon Si Thammarat province is relatively good.

Discussion and Recommendation: The second confirmed case of the West African clade in Nakhon Si Thammarat province was a Thai male with sexual diversity, who traveled from Bangkok. He was infected as a local transmission, however, there is no epidemiological evidence in Nakhon Si Thammarat province. Therefore, the Provincial Communicable Disease Committee should emphasize policy measures on Mpox surveillance covered in private hospitals/clinics, non-affiliated hospitals of the Ministry of Public Health, and drugstores, including guidelines or methods for screening the high-risk groups to be able to self–assess health status.