Evaluation of the melioidosis surveillance system in Sanpasitthiprasong Hospital, Ubon Ratchathani province, Thailand, 2018

Abstract

Background: Melioidosis is an infectious disease, gram-negative bacillus Burkholderia pseudomallei. It is endemic throughout Thailand, predominately in the Northeast region. Melioidosis has a high mortality rate, in which treatment requires specific antibiotics and the definitive diagnosis needs a positive culture of B. pseudomallei. In 2017, 656 meliodosis cases were reported in Ubon Ratchathani province. Performing an evaluation of the established facility will identify to improve the melioidosis surveillance system.
Methods: A cross-sectional study was carried out to evaluate characteristics of Sanpasitthiprasong Hospital surveillance system for melioidosis, applying both quantitative and qualitative measures. The case definition included patients visiting the Sanpasitthiprasong Hospital with fever, abscess or clinical sepsis and had laboratory result of probable case (IHA titer > 1:160 or IFA titer > 400 or found gram negative bacilli) or confirmed case (Positive culture for B. pseudomallei or 4-fold rising of IHA/IFA titer) in 2018. The quantitative attributes and the qualitative attributes were collected to assess through interviewing with the executives and relevant staff.
Results: The melioidosis surveillance system showed 89.73% of sensitivity and 60% of Predictive Value Positive. The representativeness was observed for gender, age, nationality, and occupation, which revealed good results for all variables. The completeness of gender, age, address and nation was 100%, but only 37.9% of the dates of onset were reported. The timeliness was 2%. The result of qualitative features showed that the reporting system was not complicated. However, the case definition and process of the system in the hospital were not clear. The surveillance system of melioidosis, was well accepted among the executive and staff members because of the high incidence and the severity of disease. The reporting system was flexible for the other infectious diseases. However, there was no guideline to report or appropriate communication between staff members.
Conclusion and discussion: The melioidosis surveillance system revealed the sensitivity at high level but the PVP was moderate, as previous cases were repeatedly reported, and there was delayed in reporting but it was not necessary for the melioidosis. Communication and reorganization are needed for the improvement of the surveillance the system.