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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 3  |  Issue : 1  |  Page : 42-45

Rate of children at Thailand–Myanmar border area prone to tuberculosis infection: An epidemiological prediction with referencing to bacillus Calmette–Guerin vaccination in Thailand


1 Medical Academic Center, Bangkok, Thailand
2 Department of Community Medicine, Dr. DY Patil University, Pune, Maharashtra, India

Date of Submission17-Nov-2018
Date of Decision28-Jan-2019
Date of Acceptance31-Jan-2019
Date of Web Publication13-Mar-2019

Correspondence Address:
Dr. Beuy Joob
Medical Academic Center, Bangkok
Thailand
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bbrj.bbrj_21_19

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  Abstract 


Background: The high incidence of tuberculosis exists in several areas around the world. In Indochina, the area between Thailand and Myanmar is presently the problematic endemic area of tuberculosis. The extremely high incidence of tuberculosis at this area becomes an important global public health consideration. Methods: In this specific article, the authors perform a mathematical model study based on the local available data on the efficacy and coverage rate of Bacillus Calmette–Guerin vaccination in Thailand. The specific situation at the Thailand–Myanmar border is focused in the present assessment. Results: The high incidence of children at Thailand–Myanmar border area prone to tuberculosis infection can be detected. Conclusion: The increase Bacillus Calmette–Guerin coverage and finding for new effective tuberculosis vaccine might be necessary for reduce the problem of high incidence of tuberculosis at the Thailand and Myanmar border area.

Keywords: Bacillus Calmette–Guerin, border, coverage, efficacy, Indochina, tuberculosis


How to cite this article:
Joob B, Wiwanitkit V. Rate of children at Thailand–Myanmar border area prone to tuberculosis infection: An epidemiological prediction with referencing to bacillus Calmette–Guerin vaccination in Thailand. Biomed Biotechnol Res J 2019;3:42-5

How to cite this URL:
Joob B, Wiwanitkit V. Rate of children at Thailand–Myanmar border area prone to tuberculosis infection: An epidemiological prediction with referencing to bacillus Calmette–Guerin vaccination in Thailand. Biomed Biotechnol Res J [serial online] 2019 [cited 2019 Jul 22];3:42-5. Available from: http://www.bmbtrj.org/text.asp?2019/3/1/42/254100




  Introduction Top


Pathogenic Mycobacterium is an important group of pathogen in clinical medicine. There are several kinds of pathogenic mycobacteria that can cause the disease in human beings. An important mycobacterial infection is tuberculosis, which is a well-known disease in medicine. Tuberculosis is a well-known infection for the clinical practitioner. The tuberculosis might manifest in several ways, but the common clinical presentation is the lung problem. Chronic cough, hemoptysis, and unexplained weight loss are common clinical features of tuberculosis. The effective diagnosis is required and the close follow-up on antibiotic treatment for any infected cases is necessary.

Tuberculosis is a problematic mycobacterial infection that is the present global public health threat. The high incidence of tuberculosis exists in several areas around the world and results in burdens at those areas. The poverty and poor sanitation are the basic underlying factors inducing the high prevalence of tuberculosis in several poor developing countries.[1],[2],[3],[4],[5] The WHO presently states that there are several countries that are the important foci that are the exact problematic point for global tuberculosis control.[6] Of 16 problematic countries proposed by WHO in 1998, many countries locate in tropical Southeast Asia region, Indochina.[6]

In Indochina, the area between Thailand and Myanmar is presently the problematic endemic area of tuberculosis.[7],[8],[9] In the border area between Thailand and Myanmar, the landscape is usually the mountainous area with green tropical rain forests. There are many local ethic people who live in the remoted area far from civilization. Those people are usually poor and lack of health knowledge. In addition, many specific zones in this area are still considered red zone of zone with local military conflict between minorities and local governments. It is no doubt that there are many important neglected diseases in this area. The good examples of important endemic disease in this area are malaria and filariasis. High prevalence of several infections including to tuberculosis is observable in this specific area. The extremely high incidence of tuberculosis at this specific area becomes an important global public health consideration. In this specific article, the authors perform a mathematical model study based on the local available data on the efficacy and coverage rate of Bacillus Calmette–Guerin (BCG) vaccination. The specific situation at the Thailand–Myanmar border is specifically focused in the present assessment.


  Methods Top


This study is a mathematical model study using the locally available data on tuberculosis situation. The model is developed based on the standard joint probability mathematic principle. The study is not a human or animal or specimen study and requires no ethical approval for clinical experiment/trial. The specific situation at the Thailand–Myanmar border is focused in the present assessment. The available published local data are used as primary data for mathematical modeling.

To predict the rate of children living at Thailand–Myanmar border area, who are prone to tuberculosis, the specific published data on efficacy of BCG vaccine[10] and BCG coverage rate[11] in Thailand are used as primary data. The predicted rate is hereby calculated by “1 − BCG coverage rate × BCG efficacy rate” and presented in percentage.


  Results Top


According to the available data, the efficacy of BCG vaccine and BCG coverage rates for the pediatric population at Thailand–Myanmar border area in Thailand are equal to 92.3% and 83%, respectively. Hence, the expected rate of rate of children living at Thailand–Myanmar border area who are prone to tuberculosis is hereby equal to 23.39%.


  Discussion Top


Mycobacteria are a specific group of bacteria that might cause the health problem. Mycobacterial infection is still the global public health issue.[12] Tuberculosis, the most important Mycobacterial infection, still exists in several areas of the world and usually the threaten for those specific areas. The international border area is still the area that is vulnerable for difficulty in management of health problem. The transboundary disease control and management is the present global public health consideration.[13] The poor situation is usually seen in the international border areas located at remoted regions in developing areas of the world. The control of transboundary disease migration is usually difficult in those areas.[14] Several limitations are common in any remoted international border areas. Tuberculosis is an important disease that is mentioned for its important in transboundary medicine. The diseases brought to the new settings by the migrants who cross international border become a great issue to be considered in public health. Shete et al. noted that tuberculosis among migrants at the international border area was important problem to be managed.[15] Shete et al. noted that the concept for management of the tuberculosis for this specific group was not different from that for other groups.[15] Shete et al. noted that the migrants usually had additional risks related to their country of origin and the migration process, which must be gently considered in developing comprehensive disease prevention and treatment strategies.[15]

The problem of tuberculosis at international border area in developing zone of Asia still presently exists.[16],[17] One of the hottest foci of tuberculosis in our world at present is Indochina. This area is a tropical zone of the world and the tuberculosis is highly endemic. In this area, the high incidence of tuberculosis and multidrug-resistant tuberculosis is observable.[18],[19],[20] Due to the poor local sanitation system, limited infrastructure, unstable local situation, and poverty, the local people at the border area between Thailand and Myanmar have high risk to get infected. Nevertheless, the local observation on the antituberculosis drug treatment failure is also reported in this area.[9] Up to 22.5% of the tuberculosis treatment result in this area are considered failures.[9] Tschirhart et al. studied the situation of tuberculosis at Thailand and Myanmar border area noted that incomplete surveillance data, migrant patient mobility, and loss to follow-up were the main factors leading to difficulty in estimation for the disease burden as well as tuberculosis control in this area.[21]

For management of tuberculosis, the prevention is the recommended. Vaccination is a primary prevention that is useful for controlling of several diseases including to tuberculosis. It is no doubt that the best preventive mean against tuberculosis is neonatal BC vaccination. The usefulness of the BCG vaccination is proven worldwide including to Myanmar.[22] Indeed, the usefulness of BCB vaccination is seen in several developing Asian countries. In a recent publication from Pakistan, it is proven that BCG vaccination is strongly related to the decreased severity of tuberculosis.[23] Hasan et al. noted that BCG played important role in protection against severe forms of disease in tuberculosis high-burden area.[23] It is proven that the BCB vaccination is a cost-effective preventive strategies against the disease.[24],[25],[26],[27] Tu et al. noted that governments of endemic countries should make proper public health decisions on BCG vaccination policies which can lead to the success in tuberculosis control in each setting.[24]

Nevertheless, the nonsuccess of the vaccination is a common phenomenon seen in several settings. According to this study, a very high expected incidence of children at Thailand and Myanmar border area prone to tuberculosis infection can be derived. Although the BCG vaccination has been the routine free vaccine in Thailand for a several decades, the coverage of the vaccine is still not 100%.[28],[29],[30] In fact, in the cities of Thailand, the coverage of the vaccine, including to the rate seen in the underprivileged groups such as those who live in slums, the BCG coverage is usually 100%.[30] The BCG coverage observed in Thailand is better than that seen in other nearby Indochina country such as Laos (about 82.2%–88.3%[31]). In Laos, the poverty is the main barrier for access to BCG vaccination.[31] Focusing on Cambodia, another neighboring country to Thailand, in the Cambodian capital, Phnon Penh, a higher coverage (near 100%) was observed and the socioeconomical status of the family is the important determinant for vaccination coverage.[32] The similar problem of BCG coverage in rural village is also reported.[33]

In the present study, the specific zone in Thailand in the present study is an actual remoted dangerous area, the border area. Access to the health-care facilities is usually difficult for the local people in that area. Furthermore, the health-care personnel usually have the difficulty in transportation to give the basic health care to the local people living at the border area. The use of mobile team might help solve some problems in some areas, but there is usually no sufficient team to give the service to all villages.[34] The problem of the coverage can be expected. In addition, the immunogenicity of the vaccine is still not 100%. In fact, Parkash noted that a prior exposure to common environmental mycobacteria might be a reason for poor efficacy of BCG in several endemic countries.[35] Flaherty et al. also reported a similar phenomenon.[36] Flaherty et al. noted for the requirement for development of new vaccine for using in a specific regions with elevated levels of environmental mycobacteria.[36] Both factors can result in the high rate of the pediatric population who lack for protective immunity against tuberculosis.

As a vulnerable group, there should be a specific urgent program for management of the identified problem. Since the problem is not only a local/regional problem but also a possible threat exported to other region of the world, the international concern on this problem is necessary. As noted by the WHO, both Thailand and Myanmar are the specific tropical countries that need global attention on tuberculosis control.[6] The specific border areas with more serious problem than the nonborder areas of Thailand and Myanmar should receive more special attention. The international collaboration toward the success in reduction of the number of children at Thailand–Myanmar border area prone to tuberculosis infection is required.


  Conclusion Top


Conclusively, there is a high rate of children at Thailand–Myanmar border area prone to tuberculosis infection. The increased BCG coverage and finding for new effective tuberculosis vaccine might be necessary for reduce the problem of high incidence of tuberculosis at the Thailand and Myanmar border area.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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