Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Tivanond Road, Nonthaburi, 11000, Thailand.
Division of Global Health Protection, Centers for Disease Control and Prevention, Clifton Road, Atlanta, GA, 30329, USA.
BMC Public Health. 2019 May 10;19(Suppl 3):472. doi: 10.1186/s12889-019-6774-5.
BACKGROUND: The etiology of severe pneumonia is frequently not identified by routine disease surveillance in Thailand. Since 2010, the Thailand Ministry of Public Health (MOPH) and US CDC have conducted surveillance to detect known and new etiologies of severe pneumonia. METHODS: Surveillance for severe community-acquired pneumonia was initiated in December 2010 among 30 hospitals in 17 provinces covering all regions of Thailand. Interlinked clinical, laboratory, pathological and epidemiological components of the network were created with specialized guidelines for each to aid case investigation and notification. Severe pneumonia was defined as chest-radiograph confirmed pneumonia of unknown etiology in a patient hospitalized ≤48 h and requiring intubation with ventilator support or who died within 48 h after hospitalization; patients with underlying chronic pulmonary or neurological disease were excluded. Respiratory and pathological specimens were tested by reverse transcription polymerase chain reaction for nine viruses, including Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and 14 bacteria. Cases were reported via a secure web-based system. RESULTS: Of specimens from 972 cases available for testing during December 2010 through December 2015, 589 (60.6%) had a potential etiology identified; 399 (67.8%) were from children aged < 5 years. At least one viral agent was detected in 394 (40.5%) cases, with the most common of single vial pathogen detected being respiratory syncytial virus (RSV) (110/589, 18.7%) especially in children under 5 years. Bacterial pathogens were detected in 341 cases of which 67 cases had apparent mixed infections. The system added MERS-CoV testing in September 2012 as part of Thailand's outbreak preparedness; no cases were identified from the 767 samples tested. CONCLUSIONS: Enhanced surveillance improved the understanding of the etiology of severe pneumonia cases and improved the MOPH's preparedness and response capacity for emerging respiratory pathogens in Thailand thereby enhanced global health security. Guidelines for investigation of severe pneumonia from this project were incorporated into surveillance and research activities within Thailand and shared for adaption by other countries.
背景：在泰国，常规疾病监测常常无法确定严重肺炎的病因。自 2010 年以来，泰国公共卫生部（MOPH）和美国疾病控制与预防中心（CDC）一直在进行监测，以发现严重肺炎的已知和新病因。
方法：2010 年 12 月，在泰国 17 个省的 30 家医院启动了对严重社区获得性肺炎的监测，覆盖了泰国的所有地区。该网络建立了临床、实验室、病理学和流行病学的相互关联的组成部分，并为每个部分制定了专门的指南，以协助病例调查和通知。严重肺炎的定义是胸片证实的病因不明的肺炎，患者住院 ≤48 小时，需要插管通气支持，或住院后 48 小时内死亡；排除有慢性肺部或神经疾病的患者。通过逆转录聚合酶链反应（RT-PCR）对 9 种病毒（包括中东呼吸综合征冠状病毒（MERS-CoV））和 14 种细菌进行呼吸道和病理标本检测。病例通过安全的网络报告系统报告。
结果：2010 年 12 月至 2015 年 12 月期间，972 例可检测标本中，有 589 例（60.6%）确定了潜在病因；399 例（67.8%）来自年龄 <5 岁的儿童。在 394 例（40.5%）病例中至少检测到一种病毒病原体，检测到的单一病毒病原体最常见的是呼吸道合胞病毒（RSV）（110/589，18.7%），尤其是 5 岁以下儿童。在 341 例细菌病原体检测中，有 67 例存在明显的混合感染。该系统于 2012 年 9 月增加了 MERS-CoV 检测，作为泰国疫情准备的一部分；从 767 个测试样本中没有发现病例。
结论：强化监测提高了对严重肺炎病例病因的认识，提高了 MOPH 对泰国新兴呼吸道病原体的准备和应对能力，从而增强了全球卫生安全。本项目中严重肺炎调查指南已纳入泰国的监测和研究活动，并分享给其他国家改编使用。
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