Monitoring of Enhanced Surveillance for Severe and Fatal Pneumonia, 1 st January 31 st March 2015

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1 Monitoring of Enhanced Surveillance for Severe and Fatal Pneumonia, 1 st January 31 st March The cumulative cases report since December 2010 and cases report during January to March 2015 During 1 st January to 31 st March 2015, there were 53 cases reported to the severe pneumonia database from 12 provinces including of 4 deaths. Twenty cases were reported from Surat Thani, followed by six cases each from Phra Nakhon Si Ayutthaya, Saraburi and Chiang Mai, four cases from Kamphaeng Phet, three cases each from Prachuap Khiri Khan and Chanthaburi, one case each from Kanchanaburi, Phitsanulok, Nakhon Si Thammarat, Phetchaburi and Sukhothai (Figure 1). Of 53 cases, 30 were male and 23 were female. Male to female ratio was 1.30:1. Median age was 4.5 years old (2 months to 88 years). Twenty-nine cases were children age 2 months to 5 years (54.72%) (Figure 2). Since 1 st December 2010 to 31 st March 2015 the Bureau of Epidemiology received 824 cases reported to the severe pneumonia database from 16 provinces including 159 deaths (9 cases autopsy/necropsy were done). The highest number were reported from Surat Thani (275), followed by Chiang Mai (143), Phra Nakhon Si Ayutthaya (72), Kamphaeng Phet (54), Prachuap Khiri Khan (52) and Chanthaburi (47). Of 824 cases, 496 were male and 328 were female. Male to female ratio was 1.51:1. Median age was 2 years old (2 months to 97 years). Five hundred and nine cases were children age 2 months to 5 years (61.77%). 2. Laboratory results All specimens were sent to the National Institute of Health for laboratory testing. Since 1 st December 2010 to 31 st March 2015, a total of 824 specimens were analyzed by Real time RT-PCR and conventional method, 484 specimens (58.74%) were identified as positive. During 1 st January to 31 st March 2015, the pathogens were founded and identified in 36 cases from 53 cases (Table 1). From 36 positive lab results, we found 4 cases with viral infection, 18 cases with bacterial infection and 14 cases with co-infection.

2 Severe / Fatal pneumonia cases Surat Thani Chiang Mai Phra Nakhon Prachuap Khiri Chanthaburi Kamphaeng Kanchanaburi Sukhothai Phitsanulok Saraburi Chachoengsao Si Sa Ket Chiang Rai Phetchaburi Uttaradit Nakhon Si Quarterly cases/deaths Case (1 Jan - 31 Mar 2015) Case (1 Dec Mar 2015) Provinces Figure 1 Total number of severe and fatal pneumonia cases reported to the severe pneumonia database by provinces Severe pneumonia (1 Jan - 31 Mar 2015) Fatal pneumonia (1 Jan - 31 Mar 2015) 0 2 mo. - 5 yrs yrs yrs yrs. > 60 yrs. Age Figure 2 Total number of severe/fatal pneumonia cases reported to the severe pneumonia database by age group.

3 Table 1 Laboratory results of reported severe and fatal pneumonia cases to the severe pneumonia database. (Tested by NIH) Pathogen Severe pneumonia 1 Jan 31 Mar Dec Mar 2014 Viral infection (from tracheal secretion) Adenovirus 1 28/1 Human metapneumovirus 0/4 Influenza virus A (H1N1/2009) 1 9/6 Influenza virus A/H3 0 8/5 Influenza virus B 1 4/1 Respiratory syncytial virus 06/10 Parainfluenza virus type Parainfluenza virus type 2 0 4/1 Parainfluenza virus type 3 0/3 Mixed viral infection (from tracheal secretion) Respiratory syncytial virus and Human metapneumovirus /1 Parainfluenza virus type 3 and Adenovirus 1 3/1 Parainfluenza virus type 3 and Humanmetapneumovirus Respiratory syncytial virus and Parainfluenza virus type 3 Respiratory syncytial virus and Poliovirus type 2, 3 vaccine Respiratory syncytial virus and Influenza virus A(H1N1)2009 Influenza virus A(H1N1)2009 and Adenovirus Bacterial infection (from tracheal secretion) Chlamydophila pneumoniae 2/2 Mycoplasma pneumoniae 3 21/5 3 10/2 Legionella species Streptococcus pneumoniae 0 3/2 Moraxella catarrhalis 1 9/1 Klebsiella pneumoniae 0 6/2 Pseudomonas aeruginosa Acinetobacter baumannii 0 0/3 0 3 Staphylococcus aureus 0 3/4 Burkholderia pseudomallei 0 0/2

4 Severe pneumonia Pathogen 1 Jan 3 Dec 2010 Mar Mar 2014 Acinetobacter calcoaceticus 0 0/1*** Bacterial infection (from fresh lung tissue) Staphylococcus Coagulase 0 0/1*** Chlamydophila pneumoniae 0 0/1 Acinetobacter spp. 0 0/1** Mixed bacterial infection (from tracheal secretion) Chlamydophila pneumoniae and Moraxella catarrhalis 1 4 Chlamydophila pneumoniae and Mycoplasma pneumoniae Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Klebsiella pneumoniae Mycoplasma pneumoniae and Klebsiella pneumoniae Mycoplasma pneumoniae and Moraxella catarrhalis Mycoplasma pneumoniae and Mycoplasma pneumonia, and Klebsiella pneumoniae Mycoplasma pneumoniae and Streptococcus pneumoniae 1 2 Mycoplasma pneumoniae and 2 2 Mycoplasma pneumoniae, andmoraxella catarrhalis and Klebsiella pneumoniae 1 6/12 and /1 and Streptococcus pneumoniae 0 0/1 and Burkholderia pseudomallei and Staphylococcus aureus 0 0/1, Mycoplasma pneumoniae and Haemophilus influenzae, and Moraxella catarrhalis Pseudomonas aeruginosa and Staphylococcus aureus 0 0/1 Streptococcus pneumoniae and Streptococcus pneumoniae and Moraxella catarrhalis

5 Pathogen Severe pneumonia 1 Jan 31 Mar Dec Mar 2014 Streptococcus pneumoniae, and Klebsiella pneumoniae Acinetobacter baumannii and Acinetobacter spp. Klebsiella pneumonia, Moraxella catarrhalis and Staphylococcus aureus Klebsiella pneumonia and Pseudomonas aeruginosa and Moraxella catarrhalis 0 4/1 Morganella morganii, Citrobacter freundii (Moderate), Escherichia coil (Moderate), Pseudomonas aeruginosa (Few), gamma-hemolysis Streptococci (Moderate), alpha-hemolysis Streptococci (Moderate) Moderate alpha-hemolytic Streptococci, Moderate Diphtheroid, Few Acinetobacter lwoffi 0 0/1 Mixed bacterial infection (from fresh lung tissue) Klebsiella pneumoniae and Acinetobacter lwoffi 0 0/1* Mixed bacterial infection (from fresh liver tissue) and Klebsiella pneumoniae 0 0/1* Co-infection (from tracheal secretion) Adenovirus and Acinetobacter baumannii 0 0/1 Adenovirus,, Moraxella catarrhalis and Adenovirus and Moraxella catarrhalis 1 2 Adenovirus and Mycoplasma pneumoniae Adenovirus, Streptococcus pneumoniae and Haemophilus influenzae 0 0/1 Adenovirus, Humanmetapneumovirus and Haemophilus influenzae Adenovirus and Adenovirus, Influenza virus B, Moraxella catarrhalis and Adenovirus, Parainfluenza virus type 2, Chlamydophila pneumoniae and Mycoplasma pneumonia

6 Pathogen Severe pneumonia 1 Jan 31 Mar Dec Mar 2014 Adenovirus, Chlamydophila pneumoniae and Mycoplasma pneumoniae Respiratory syncytial virus and Mycoplasma pneumoniae 0 2 Respiratory syncytial virus and Streptococcus pneumoniae 0 3 Respiratory syncytial virus and Klebsiella pneumoniae Respiratory syncytial virus and Respiratory syncytial virus and Chlamydophila pneumoniae 0 2 Respiratory syncytial virus and Moraxella catarrhalis 2 Respiratory syncytial virus and 5 Respiratory syncytial virus, and Moraxella catarrhalis Respiratory syncytial virus, and Respiratory syncytial virus, Klebsiella pneumoniae and Respiratory syncytial virus, Mycoplasma pneumoniae and Respiratory syncytial virus, Human metapneumovirus and Respiratory syncytial virus, Parainfluenza virus type 2 and Moraxella catarrhalis Respiratory syncytial virus, Parainfluenza virus type 1 and Respiratory syncytial virus, Mycoplasma pneumoniae and Streptococcus pneumoniae Respiratory syncytial virus, Haemophilus influenza and Streptococcus pneumoniae Respiratory syncytial virus, Chlamydophila pneumonia and Mycoplasma pneumoniae /1

7 Severe pneumonia Pathogen 1 Jan 3 Dec 2010 Mar Mar 2014 Influenza virus A/H3 and Acinetobacter baumannii Influenza virus A/H3 and Streptococcus pneumoniae Influenza virus A/H3 and Staphylococcus aureus /1 Influenza virus A/H3 and Klebsiella pneumoniae 0 0/1 Influenza virus A/H3 and Mycoplasma pneumoniae 1 3 Influenza virus A/H3 and Pseudomonas aeruginosa 0 0/1 Influenza virus A/H3, Chlamydophila pneumoniae, Mycoplasma pneumoniae and Streptococcus pneumoniae Influenza virus B and Pseudomonas aeruginosa Influenza virus B and 0 0/1 Influenza virus B, and Mycoplasma pneumoniae Parainfluenza virus type 3, Klebsiella pneumoniae and 0 0/1 Parainfluenza virus type 3, and Parainfluenza virus type 3 and Moraxella catarrhalis Parainfluenza virus type 3 and Mycoplasma pneumoniae 2 2 Parainfluenza virus type 3 and Humanmetapneumovirus and Humanmetapneumovirus and 0 0/1 Humanmetapneumovirus and Moraxella catarrhalis Humanmetapneumovirus and Chlamydophila pneumoniae Humanmetapneumovirus and Streptococcus pneumoniae Humanmetapneumovirus and Pseudomonas aeruginosa Humanmetapneumovirus and Mycoplasma pneumoniae Humanmetapneumovirus, Mycoplasma pneumoniae and Humanmetapneumovirus, Chlamydophila pneumoniae and Streptococcus pneumoniae Influenza virus A(H1N1) 2009 and Moraxella catarrhalis Influenza virus A(H1N1) 2009 and Mycoplasma pneumoniae 0/1 0/1 Influenza virus A(H1N1) 2009 and Acinetobacter baumannii 0 0/1

8 Severe pneumonia Pathogen 1 Jan 3 Dec 2010 Mar Mar 2014 Influenza virus A(H1N1) 2009 and Streptococcus pneumoniae /1 Influenza virus A(H1N1) 2009, Streptococcus pneumoniae and Moraxella catarrhalis Influenza virus A(H1N1)2009 and 1 2/1 Influenza virus A(H1N1)2009, Adenovirus and Acinetobacter baumannii Influenza virus A(H1N1)2009, Mycoplasma pneumoniae and Parainfluenza virus type 2, and Legionella pneumophila 0 0/1** 0/1 0/1 Parainfluenza virus type 2 and Parainfluenza virus type 1 and Chlamydophila pneumoniae Parainfluenza virus type 1 and Mycoplasma pneumoniae Parainfluenza virus type 1 and Klebsiella pneumoniae 0 0/1 Parainfluenza virus type 1 and Moraxella catarrhalis Total * Patient case1, ** Patient case2, *** Patient case3