Thailand tightens border surveillance over Yangon cholera outbreak

Thailand’s Ministry of Public Health has ordered tighter cholera surveillance at international entry points, hospitals and border communities after an outbreak in Yangon led to an increase in hospital admissions for severe diarrhoea.

The Department of Disease Control (DDC) has also been instructed to prepare laboratory testing and disease investigation and control operations.

Health authorities have urged the public not to panic, while advising people travelling to outbreak areas to take particular care with food and water and consider cholera vaccination in advance.

Returning travellers who develop severe watery diarrhoea or vomiting should seek medical attention immediately and provide their travel history.

Yangon records about 500 severe diarrhoea cases

According to DDC Director-General Dr Montien Kanasawat, official information and local media reports in Myanmar showed that about 500 people with severe diarrhoea had been admitted to hospitals in Yangon since August 9.

Of these, 149 screened positive for cholera, while nine were confirmed by Myanmar’s National Health Laboratory as infected with Vibrio cholerae.

No information has yet been released on the serogroup, serotype or biotype of the bacterium. One elderly patient with pre-existing heart and lung disease has died, although Myanmar authorities have not confirmed that cholera was the direct cause of death.

Most cases have been concentrated in central Yangon, an area with a high density of restaurants and street-food stalls. Myanmar authorities have inspected food and water quality, cleaned water supply systems, increased chlorination, disinfected the homes of patients and temporarily suspended the sale of street food considered to pose a risk.

The latest information indicates that the number of new admissions is declining, although the situation remains under close surveillance.

Based on current information, the DDC assesses the risk to the general public in Thailand as low. Cholera is transmitted through contaminated food or water rather than through respiratory transmission or casual contact.

However, people travelling to outbreak areas face a higher risk, while continued travel between Thailand and Myanmar means infected travellers could still enter the country.

Six measures ordered to strengthen preparedness

The Ministry of Public Health has ordered relevant agencies to implement six measures in response to the outbreak.

• Continue monitoring the situation, assessing risks and coordinating information with Myanmar, the World Health Organization and international networks.
   
• Strengthen surveillance and symptom screening at international points of entry, while providing advice and arranging referrals for suspected cases.
   
• Increase vigilance at healthcare facilities, particularly in border provinces and areas with Myanmar communities, with closer attention to travel histories, specimen collection and rapid case reporting.
   
• Ensure laboratories and specimen transport systems are ready to confirm infections and identify the bacteria involved.
   
• Prepare disease investigation and control teams for an immediate response if cases are detected.
   
• Tighten sanitation inspections covering food, drinking water, water for domestic use, toilets and waste disposal, particularly in migrant-worker communities and shared accommodation.

Travellers advised to avoid areas with high case numbers

DDC Deputy Director-General Dr Direk Khampaen advised people planning to travel to Myanmar to avoid areas reporting large numbers of cases. Those who need to travel may consider an oral cholera vaccine, administered in two doses two weeks apart.

Travellers should drink only sealed bottled water or boiled water, avoid ice from unknown sources and choose freshly cooked food that is still hot. Raw food, raw seafood, fresh vegetables, pre-peeled fruit and unhygienic street food should be avoided.

Travellers should also wash their hands with soap before eating and after using the toilet, follow announcements from Myanmar authorities and carry oral rehydration salts (ORS) for use if needed.

People returning from Myanmar are advised to monitor themselves for five days. Anyone who develops severe watery diarrhoea, vomiting, intense thirst, dry mouth, reduced urination, weakness or dizziness should sip ORS according to the instructions on the packet and seek medical attention promptly, while informing healthcare staff of their travel history.

The DDC also advised against self-medicating with antibiotics or anti-diarrhoeal medicines and urged anyone with symptoms to avoid preparing food for others until they have been assessed by medical or public health personnel.

Cholera can be treated if fluids and medical care are provided promptly, but severe diarrhoea can lead to serious dehydration, shock and death.

The public is therefore advised to follow the “cooked, hot and clean” principle, drink safe water and wash their hands regularly with soap, while seeking medical attention promptly if symptoms develop.