Melioidosis Situation in Thailand, 2024

Abstract

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In 2024, according to data from the digital disease surveillance system (DDS) of the Division of Epidemiology, Department of Disease Control, a total of 4,157 cumulative cases of melioidosis were reported, with 133 fatalities, resulting in a case fatality rate of 3.2%. The majority of patients resided in the Northeastern region. Additionally, a study aiming to monitor Antimicrobial Resistance (AMR) using microbiology laboratory data, hospital admission data and AMASS (AutoMated tool for Antimicrobial resistance Surveillance System) from 111 hospitals under the Ministry of Public Health (MoPH) across Health Service Areas 1-12 in 2022 revealed 4,407 cultured-confirmed melioidosis cases with 1,219 patients died during hospitalization, indicating a hospital case fatality rate of 27.7%. Event-Based Surveillance (EBS) data of the Division of Disease Control in Emergency Situation, Department of Disease Control, in 2024, reported 83 culture-confirmed melioidosis deaths (one death per event). Individuals with underlying health conditions were noted in 93.1% of cases. The average duration from onset of illness to medical access was 3 days, and the time from admission to death was 4 days. About 72.7% (16/22) received antibiotics effective against Burkholderia pseudomallei, such as Ceftazidime and Meropenem. Notably, 37.5% (6/16) received antibiotics before culture confirmation. Common risk factors included exposure to soil and water without protective equipment during agricultural activities such as rice farming, gardening, and vegetable cultivation (82.5%), animal husbandry (67.3%), as well as wading through water or mud (32.7%).

This situation reflects the severity of the disease among hospitalized patients with advanced symptoms and underscores the environmental contamination of Burkholderia pseudomallei in many areas, not limited to the Northeastern region. Risk factors are related to lifestyle and environmental conditions, such as waterlogging during the rainy season, which increases the likelihood of infection and death—especially among high-risk groups with underlying diseases like diabetes.

Recommendations for disease control should focus on strengthening surveillance, especially by supporting complete reporting of culture-confirmed melioidosis cases through the DDS. Timely diagnosis and appropriate antibiotic treatment—particularly for patients with severe sepsis—are crucial. Empirical treatment with Ceftazidime in combination with other medicines, as deemed appropriate by physicians, can help reduce severe complications and mortality rates of melioidosis. Additionally, preventive measures should be promoted, including wearing boots while engaging in agricultural activities, thoroughly cleaning the body after exposure to soil or water, consuming safe food and drinking water, and using uncontaminated water sources. Awareness should also be raised among at-risk groups to seek early diagnosis and adhere strictly to medical treatment for at least 3 to 6 months to reduce complications.