Investigation of the first severe case of box jellyfish envenomation in Rayong province, Thailand, 2016

Abstract

Background: On 3^rd September 2016, the Bureau of Epidemiology was notified about a suspected case of Box Jellyfish, which was the first reported case from Rayong province. We conducted an investigation to verify diagnosis and recommend measures for preventing severe injuries and deaths.
Methods: The descriptive study was performed by medical records reviewed, interviewed public health officer, case’s family, witnesses and searching for the previous cases from medical database during the year 2014-2016. The environmental study and reviewed of the previous jellyfish sampling result in this area were carried out. In addition, we interviewed some local people, officers for the knowledge about jellyfish first aid and assessed the preventive measures for jellyfish injury.
Results: We found one jellyfish envenomation case, an 11-years-old Italian girl, contacted a jellyfish while swimming on 2 September 2016. Her signs and symptoms compatible with injuries from multi-tentacle box jellyfish. Parents removed the tentacles and cleaned the wound with fresh water. Someone applied the vinegar and morning glory leaf on the wound afterward. The case visited a health center in the island and referred to a private hospital on the same day. The event place was a curved beach, with calm sea condition and occurred in a shallow water at waist level. During 2014 - 2016, there were 3 previous cases but could not identify type of jellyfish due to inadequate information. The marine biological center at Eastern part of the Gulf of Thailand found box jellyfish samples in this island and the nearby islands in 2014 and 2016, but no sample was found at the affected beach from the survey 1 day after the event. Many people in this island have incorrect knowledge for first aid of jellyfish venomous. Among six popular beaches, only one had warning sign of jellyfish and a vinegar pole, but had no vinegar bottle.
Conclusions: Prevention measures and surveillance network of jellyfish injury should be implemented in this island and nearby, especially to have education signage of jellyfish first aid and vinegar poles in popular tourist beaches in Rayong province.