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On 1 Dec 2020, the Thai Department of Disease Control was notified of five COVID-19 infections among passengers on a flight from Switzerland to Thailand. The objectives of this investigation were to confirm the outbreak, describe epidemiological characteristics, and identify the source of infection. We performed a descriptive study and contact tracing among the flight’s passengers. We interviewed the cases and reviewed their medical records, as well as an environmental survey of the state quarantine facility. Whole genome sequencing to determine the percentage alignment identity for RT-PCR-positive cases was conducted. Thirteen infected passengers out of 107 people on the flight (12.1%) were identified. The suspected index case was a symptomatic passenger, non-mask-wearing passenger. Five of the 13 confirmed cases shared a similar genomic pattern (98–100% alignment identity), and four cases sat within one row either in front of or behind the suspected index case. The genomes of the cases were more similar to each other than those uploaded to the GISAID database from Switzerland. The symptomatic COVID-19 passenger without mask wearing was suspected to be the source. Mask wearing should be mandated on flight to prevent spreading of respiratory infectious diseases.

During the first wave of the coronavirus disease (COVID-19) epidemic in Thailand, 3 Jan to 22 Jun 2020, there were 3,151 confirmed cases and 58 related deaths. This study aimed to describe epidemiological characteristics of the deaths and explore risk factors using a retrospective cohort study design. A COVID-19 related death was defined as a confirmed COVID-19 case who died from a clinically compatible illness. We collected data from investigation reports and medical records using a semi-structure questionnaire and retrieved secondary data from the Department of Disease Control’s database. Of the 58 deaths, the median age was 58 years (interquartile range (IQR) 50-70), 44 were male, and underlying disease was found in 44, hypertension being the most common. The median time from onset to diagnosis date was 7 days (IQR 5-9) compared to 4 days (IQR 2-7) in recovered cases. Six were nosocomial infections and of the remaining 52, 36 had visited a medical facility at least once before they were hospitalized. Male, elderly, and delayed diagnosis were found to be positively associated with death. Early detection of COVID-19 cases should be strengthened in health care facilities throughout Thailand.

Thailand is classified by the World Health Organization as one of a few countries in the world with the highest tuberculosis (TB) burden. The Thai Ministry of Public Health has implemented the ‘Tuberculosis Case Management’ (TBCM) as the main database for the national TB surveillance. TBCM is designed for case registration and management as well as case reporting and notification. This study thus aimed to evaluate TBCM for its surveillance function. A cross-sectional descriptive study was conducted to review the surveillance function of TBCM during 1 Jan to 30 Jun 2017 at Mae Sot Hospital, Thailand. The study team reviewed the protocols and guidelines of TBCM. The practice of health personnel at the TB clinic was observed to determine the data flow of TBCM. Qualitative and quantitative study methods were employed in accordance with the Center for Disease Control and Prevention’s Guidelines for Evaluating Surveillance Systems. We found that TBCM reporting system at Mae Sot Hospital was acceptable, stable and useful in achieving the objectives of TB control program. Sensitivity and positive predictive value of TBCM accounted for 80.8% and 99.4% respectively. The most common reason of miss-reporting was a loss to follow-up after admission or after health exam, particularly amongst non-Thai patients. Timeliness and data quality were concerned attributes that required improvement. TBCM and the in-house medical recording system should be harmonized to mitigate the risk of erroneous coding.

On October 2020, there was a bus-train collision at Chachoengsao Province with 18 fatalities. The Division of Epidemiology conducted a joint investigation during October 2020 to describe characteristics of the event and deaths, and identify factors associated with fatalities. A descriptive study was conducted by interviewing officers, witnesses, policemen, rescuers and survivors. We also reviewed medical records and closed-circuit television and performed environmental survey of the roads and bus wreckage. A retrospective cohort study was performed with multiple logistic regression and Haddon matrix analyses. The bus collided with a cargo train at an illegal road-railway crossing intersection. Eighteen people died (25.4%). Most deaths were caused by lethal injuries to the head and neck (17/18, 94.4%). The bus was overloaded and turning on loud music. The intersection did not have crossing gates and the warning signal was broken. This bus-train collision resulted in high fatality. Standing on the overloaded bus was the significant risk of death. Regulations of noise limits, number of passengers, limit standing on the buses, and improvement of safety controls for all road-railway intersections should be strictly implemented for injury prevention.