Consecutive fatalities from Box Jellyfish Envenomation in Surat Thani, Thailand, 2015: An unresolved problem

Abstract

Background: Between July to October 2015, Department of Disease Control received notifications of two events of suspected box jellyfish envenomation deaths in Surat Thani. Investigation was conducted to confirm the diagnosis, describe characteristics of injury and recommend appropriate measures.
Methods: Descriptive study was performed. We inspected the cases’ bodies, reviewed medical records, interviewed victim’s friends, locals and healthcare providers, and collected jellyfish sample for species identification. Active case finding was conducted. Walk-through survey of environment to assess availability of preventive measures and first aid equipment was conducted. Locals were interviewed in aspect of awareness and knowledge.
Results: Two deaths included 31-year-old Thai female, died on 31st July 2015 at Pha Ngan island and 20-year-old foreign female, died on 6th October 2015 at Samui island. Both victims submerged in calm and shallow seawater at night. After being attacked, they painfully screamed but nearby people lately aware of the cause of injury. Inappropriate first aid procedures were given to them including the wrong removal of box jellyfishes’ tentacles from bodies and inadequate vinegar treatment. They were resuscitated and died at hospitals. Additional 2 probable and 1 suspected cases were found. Most local warning signs did not provide first aid knowledge and vinegar poles were not visible.
Conclusions: Inappropriate first aid, including removing tentacles and delay in rinsing vinegar, possibly precipitated fatality. Not only increasing warning signs and vinegar poles but also emphasizing awareness and first aid knowledge of locals were the essential key to prevent further deaths.