Epidemics in Cholera-endemic Areas with Multiple Drug Resistance in Ranong, Thailand, 2011
Keywords:
Cholera, Outbreak, Multiple drug resistance, Ranong, ThailandAbstract
Background: In mid of July 2011, Bureau of Epidemiology (BoE) was notified about 1 cholera case in Ranong province by PHO, after that the outbreak was observed and found that it was still going on (96 cases in 13 weeks). Therefore an investigation by FETP was conducted to confirm outbreak, review cholera events in the past 8 years, study trend of multiple drugs resistance and proportion of RSC test among diarrheal cases, antibiotic use and cost during the outbreak.
Methods: Numbers of cholera cases in 2003 - 2011 and cases investigation report were reviewed. A case was defined as a person who lived in Ranong province who had any diarrheal symptom from 1st July to 31st December 2011 and stool/rectal swab culture positive for Vibrio cholerae O1 or O139. Lab investigations were also done by collecting stool to identify the organism and drug sensitivity. We sampled (simple random sampling technique) medical records of diarrhea and cholera treated in cases Ranong hospital between July and November 2011, reviewed proportion of RSC test among diarrheal cases and antibiotic use. The treatment and management costs were calculated.
Results: In the past 8 years, there were 5 cholera events and 1 outbreak in 2007. In 2011, the epidemic curve suggested epidemic on top of endemic. All organisms found in the outbreak were Vibrio cholerae O1 El Tor Ogawa resistance to ampicilin, doxycycline, cotrimoxazole, tetracycline and erythromycin. 343 medical records of Ranong hospital were collected. 311 out of 343 were diarrheal cases and 32 were cholera cases. More than 80% of diarrheal and cholera cases were treated with antibiotics. Proportion of RSC test among diarrheal cases was increased from 10% to 75% between July and December. The cost that used in treatment and controls the outbreak was around 5.4 million Bath.
Conclusion: Cholera is endemic in Ranong and Vibrio cholerae in epidemic on top of endemic was resistant to several antibiotics drugs. In order to prevent increased multiple drugs resistance and reduce unnecessary costs, antibiotic should be used in patients with severe dehydration.
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