Melioidosis in Thailand: Present and Future
Authors: Hinjoy Soawapak , Hantrakun Viriya , Kongyu Somkid , Kaewrakmuk Jedsada , Wangrangsimakul Tri , Jitsuronk Siroj , Saengchun Weerawut , Bhengsri Saithip , Akarachotpong Thantapat , Thamthitiwat Somsak , Sangwichian Ornuma , Anunnatsiri Siriluck , Sermswan Rasana W , Lertmemongkolchai Ganjana , Sitthidet Tharinjaroen Chayada , Preechasuth Kanya , Udpaun Ratchadaporn , Chuensombut Poomin , Waranyasirikul Nisarat , Anudit Chanihcha , Narenpitak Surapong , Jutrakul Yaowaruk , Teparrukkul Prapit , Teerawattanasook Nittaya , Thanvisej Kittisak , Suphan Alisa , Sukbut Punchawee , Ploddi Kritchavat , Sirichotirat Poolsri , Chiewchanyon Bongkoch , Rukseree Kamolchanok , Hongsuwan Maliwan , Wongsuwan Gumphol , Sunthornsut Pornpan , Wuthiekanun Vanaporn , Sachaphimukh Sandy , Wannapinij Prapass , Chierakul Wirongrong , Chewapreecha Claire , Thaipadungpanit Janjira , Chantratita Narisara , Korbsrisate Sunee , Taunyok Apichai , Dunachie Susanna , Palittapongarnpim Prasit , Sirisinha Stitaya , Kitphati Rungrueng , Iamsirithaworn Sopon , Chaowagul Wipada , Chetchotisak Ploenchan , Whistler Toni , Wongratanacheewin Surasakdi , Limmathurotsakul Direk 
Published: April 2018

A recent modelling study estimated that there are 2800 deaths due to melioidosis in Thailand yearly. The Thailand Melioidosis Network (formed in 2012) has been working closely with the Ministry of Public Health (MoPH) to investigate and reduce the burden of this disease. Based on updated data, the incidence of melioidosis is still high in Northeast Thailand. More than 2000 culture-confirmed cases of melioidosis are diagnosed in general hospitals with microbiology laboratories in this region each year. The mortality rate is around 35%. Melioidosis is endemic throughout Thailand, but it is still not uncommon that microbiological facilities misidentify Burkholderia pseudomallei as a contaminant or another organism. Disease awareness is low, and people in rural areas neither wear boots nor boil water before drinking to protect themselves from acquiring B. pseudomallei. Previously, about 10 melioidosis deaths were formally reported to the National Notifiable Disease Surveillance System (Report 506) each year, thus limiting priority setting by the MoPH. In 2015, the formally reported number of melioidosis deaths rose to 112, solely because Sunpasithiprasong Hospital, Ubon Ratchathani province, reported its own data (n = 107). Melioidosis is truly an important cause of death in Thailand, and currently reported cases (Report 506) and cases diagnosed at research centers reflect the tip of the iceberg. Laboratory training and communication between clinicians and laboratory personnel are required to improve diagnosis and treatment of melioidosis countrywide. Implementation of rapid diagnostic tests, such as a lateral flow antigen detection assay, with high accuracy even in melioidosis-endemic countries such as Thailand, is critically needed. Reporting of all culture-confirmed melioidosis cases from every hospital with a microbiology laboratory, together with final outcome data, is mandated under the Communicable Diseases Act B.E.2558. By enforcing this legislation, the MoPH could raise the priority of this disease, and should consider implementing a campaign to raise awareness and melioidosis prevention countrywide.