Monitoring of Enhanced Surveillance for Severe and Fatal Pneumonia, 1 April - 30 June 2014

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1 Monitoring of Enhanced Surveillance for Severe and Fatal Pneumonia, 1 April - 3 June The cumulative cases report since December 21 and cases report during April to June 214 During 1 April to 3 June 214, there were 52 cases reported through the severe pneumonia database from 13 provinces including of 6 deaths (one autopsy). Thirteen cases were reported from Surat Thani, Chiang Mai 8 cases, Phra Nakhon Si Ayutthaya 6 cases, Prachuap Khiri Khan, Si Sa Ket and Kamphaeng Phet 5 cases each, Chanthaburi 3 cases, Saraburi 2 cases, Phetchaburi, Sukhothai, Nakhon Si Thammarat, Chiang Rai and Kanchanaburi 1 case each.(figure 1) By Thirty-two cases were male and 2 were female. Female to male ratio was 1.6:1. Mean age was 33 years old (2 months 95 years). Eighteen cases were children age under 2 year old (34.62%) Since 1 December 21 to 3 June 214 the Bureau of Epidemiology received 622 cases reported through the severe pneumonia database from 17 provinces including 139 deaths (9 cases were autopsy). The highest number was reported from Surat Thani (194), the rest were from cases from Chiang Mai (125), Phra Nakhon Si Ayutthaya (52), Prachuap Khiri Khan (39) and 33 cases reported from Chanthaburi. Of 622 cases, 375 were male and 247 were female. Female to male ratio was 1.52:1. Mean age was 21 years old (2 months 97 years). Three hundred and eighty six cases were children age under 5 years old (62.6%). (Figure 2, 3) 2. Laboratory result All specimens were sent to the National Institute of Health for laboratory testing. Since 1 December 21 to 3 June 214, Of 612 cases, 348 were positive (56.86%). During 1 April to 3 June 214, the pathogens were founded and identified in 27 cases from 47 cases (57.44%). Table 1 shows the laboratory results of both periods.

2 Quarterly cases/deaths Apr - 3 Jun Dec 21-3 Jun Cumulative cases/deaths Surat Thani Chiang Mai Phra Nakhon Si Ayutthaya Prachuap Khiri Khan Chanthaburi Kamphaeng Phet Kanchanaburi Sukhothai Phitsanulok Saraburi Chachoengsao Provinces Si Sa Ket Chiang Rai Phetchaburi Uttaradit Nakhon Si Thammarat Ubon Ratchathani Figure 1 Total number of severe and fatal pneumonia cases reported through the severe pneumonia database by provinces severe pneumonia cases cases (1 April - 3 June 214) cases (1 Dec 21-3 Jun 214) 2 mo.- 5 yrs 6-2 yrs 21-4 yrs 41-6 yrs >6 yrs Age Figure 2 Total number of severe pneumonia cases reported through the severe pneumonia database by age group Cumulative severe pneumonia cases

3 6 Fetal pneumonia cases(1 Apr - 3 Jun 214) Cumulative Fatel pneumonia cases (1 Dec 21-3 Jun 214) 4 Fatal pneumonia cases mo.- 5 yrs 6-2 yrs 21-4 yrs 41-6 yrs >6 yrs Age Cumulative fatsl pneumonia cases Figure 3 Total number of fatal pneumonia cases reported through the severe pneumonia database by age group.

4 Table 1 Laboratory results of reported severe and fatal pneumonia cases through the severe pneumonia database. (Tested by NIH) Pathogens 1 Dec 21 3 Jun Apr 3 Jun 214 Viral infection (from tracheal secretion) Adenovirus 3 23 Coronavirus Enterovirus Human metapneumovirus 1 5/4 Influenza virus A/H1N /4 Influenza virus A/H3 2 7/5 Influenza virus B 1 3 Respiratory syncytial virus 87/9 Parainfluenza virus type 1 8 Parainfluenza virus type 2 3/1 Parainfluenza virus type 3 1 9/3 Mixed viral infection (from tracheal secretion) Respiratory syncytial virus and Human metapneumovirus /1 Parainfluenza virus type 3 and Adenovirus 2 2/1 Parainfluenza virus type 3 and Humanmetapneumovirus Respiratory syncytial virus and Poliovirus type 2, 3 vaccine Respiratory syncytial virus and Influenza virus A/H1N1 29 Influenza virus A/H1N1 29 and Adenovirus Bacterial infection (from tracheal secretion) Chlamydophila pneumoniae 4/2 Mycoplasma pneumoniae 1/5 Haemophilus influenzae 3 7/1 Legionella species Legionella pneumophila Streptococcus pneumoniae 1 2/2 Moraxella catarrhalis 6/1 Klebsiella pneumoniae 4 5/1 Pseudomonas aeruginosa Acinetobacter baumannii /1 Stenotrophomonas maltophilia Escherichia coli 3

5 Pathogens 1 Dec 21 3 Jun Apr 3 Jun 214 Bacterial infection (from tracheal secretion) Staphylococcus aureus 2/4 Burkholderia pseudomallei /2 Acinetobacter calcoaceticus /1*** Bacterial infection (from fresh lung tissue) Staphylococcus coagulase /1*** Chlamydophila pneumoniae /1 Acinetobacter spp. /1** Mixed bacterial infection (from tracheal secretion) Chlamydophila pneumoniae and Moraxella catarrhalis 3 Mycoplasma pneumonaie and Klebsiella pneumoniae Mycoplasma pneumoniae and Moraxella catarrhalis Escherichia coli and Klebsiella pneumoniae /1 5/11 Escherichia coli and Haemophilus influenzae /1 Escherichia coli and Streptococcus pneumoniae /1 Escherichia coli and Burkholderia pseudomallei Escherichia coli and Staphylococcus aureus /1 Escherichia coli, Mycoplasma pneumoniae and Haemophilus influenzae Escherichia coli, Haemophilus influenzae and Moraxella catarrhalis Pseudomonas aeruginosa and Staphylococcus aureus /1 Streptococcus pneumonia and Haemophilus influenzae 1 1 Streptococcus pneumonia and Moraxella catarrhalis Acinetobacter baumannii and Acinetobacter spp. Klebsiella pneumoniae, Moraxella catarrhalis and Staphylococcus aureus Klebsiella pneumoniae and Pseudomonas aeruginosa 1 1 Morganella morganii, Citrobacter freundii (Moderate), Escherichia coil (Moderate), Pseudomonas aeruginosa (Few), gamma-hemolysis Streptococci (Moderate), alpha-hemolysis Streptococci (Moderate) Mixed bacterial infection (from fresh lung tissue) Klebsiella pneumoniae and Acinetobacter lwoffi /1* Mixed bacterial infection (from fresh liver tissue) Escherichia coli and Klebsiella pneumoniae /1*

6 Pathogens 1 Dec 21 3 Jun Apr 3 Jun 214 Co-infection (from tracheal secretion) Adenovirus and Acinetobacter baumannii /1 Adenovirus, Haemophilus influenzae, Moraxella catarrhalis and Escherichia coli Adenovirus and Moraxella catarrhalis Adenovirus, Streptococcus pneumoniae and Haemophilus influenzae /1 Adenovirus and Haemophilus influenzae 1 1 Respiratory syncytial virus and Mycoplasma pneumoniae Respiratory syncytial virus and Streptococcus pneumoniae 3 Respiratory syncytial virus and Klebsiella pneumoniae Respiratory syncytial virus and Escherichia coli Respiratory syncytial virus and Chlamydophila pneumoniae Respiratory syncytial virus and Moraxella catarrhalis 6 Respiratory syncytial virus and Haemophilus influenzae 8 Respiratory syncytial virus, Haemophilus influenzae and Escherichia coli 3 Respiratory syncytial virus, Klebsiella pneumoniae and Escherichia coli Respiratory syncytial virus, Mycoplasma pneumoniae and Haemophilus influenzae Respiratory syncytial virus, Human metapneumovirus and Escherichia coli Respiratory syncytial virus, Parainfluenza virus type 2 and Moraxella catarrhalis Respiratory syncytial virus, Mycoplasma pneumoniae and Streptococcus pneumoniae /1 Influenza virus A/H3 and Streptococcus pneumoniae Influenza virus A/H3 and Staphylococcus aureus /1 Influenza virus A/H3 and Klebsiella pneumoniae /1 Influenza virus A/H3 and Mycoplasma pneumoniae 2 Influenza virus A/H3, Pseudomonas aeruginosa /1 Influenza virus B and Pseudomonas aeruginosa Influenza virus B and Escherichia coli /1 Influenza virus B, Escherichia coli and Mycoplasma pneumoniae Parainfluenza virus type 3, Klebsiella pneumoniae and Escherichia coli /1 Parainfluenza virus type 3, Haemophilus influenzae and Escherichia coli Humanmetapneumovirus and Escherichia coli Humanmetapneumovirus and Haemophilus influenzae /1 Humanmetapneumovirus and Moraxella catarrhalis

7 Pathogens 1 Apr 3 Dec 21 Jun Jun 214 Influenza virus A/H1N1 29 and Moraxella catarrhalis Influenza virus A/H1N1 29 and Acinetobacter baumannii /1 Influenza virus A/H1N1 29, Streptococcus pneumoniae 1 1/1 Influenza virus A/H1N1 29, Streptococcus pneumoniae and Moraxella catarrhalis Influenza virus A/H1N1 29 and Haemophilus influenzae /1 Influenza virus A/H1N1 29, Adenovirus and Acinetobacter baumannii /1** Parainfluenza virus type 2, Haemophilus influenzae and Legionella pneumophila Parainfluenza virus type 2 and Escherichia coli Parainfluenza virus type 1 and Chlamydophila pneumoniae Parainfluenza virus type 1 and Mycoplasma pneumoniae Parainfluenza virus type 1 and Klebsiella pneumoniae /1 /1 Total * Same patient, **Same patient, *** Same patient