Investigation of Probable Box Jellyfish Envenomation at Koh Kood, Trat Province, Thailand, December 2012

Abstract

Background: Reported Box Jellyfish envenomation in Thais is rare. In December 2012, the Bureau of Epidemiology (BoE) received a notification through jellyfish surveillance system about a 2-year-old girl survived from suspected Box Jellyfish envenomation in KohKood, Trat province. We conducted an investigation to confirm a Box jellyfish envenomation, determine a situation of Box jellyfish, recommend prevention and improve a Jellyfish first aid standard.
Methods: A descriptive study and environmental study were performed. We reviewed medical record, interviewed with case’s family, healthcare providers and locals, collected Jellyfish sample for species identification, do an active case finding in village. A suspected case was defined as a person who contacted with seawater or associated object and developed a painful whip-like lesion at skin in KohKood during 1-13 December 2012. A probable case was a suspected case with one of the followings: loss of consciousness, abnormal breathing, Irukundji syndrome, or death. A confirmed case must have evidence of box jellyfish species confirmation.
Results: The case was a 2 years old Thai tourist girl from Chanthaburi Province. On 9 December 2012, while she played in shallow seawater, she suddenly screamed and became unconscious. After receiving first aid at beach, she regained conscious with a whip marks with frosted ladder pattern at her legs. In active case finding, we found 2 contact cases with papules, one contact at chest and arms and one contact at arm, as a result of contact with the girl skin. For environmental survey, an affected place had calm water and slope beach with mangrove forest, a favorite Box Jellyfish habitat, but we did not find a Box Jellyfish from survey.
Conclusions: A probable Box Jellyfish envenomation was reported by Thai surveillance network. No Box Jellyfish was captured in the affected area. KohKood Jellyfish situation is not severe but still have a chance to face more Box Jellyfish envenomation cases due to suitable environment for Box Jellyfish living. To minimize risks of Box Jellyfish envenomation, improving Jellyfish surveillance system, raising awareness of Jellyfish problem, implementing prevention measures and research for Box Jellyfish type and distribution should be carried out.