|Year : 2019 | Volume
| 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
Beuy Joob1, Viroj Wiwanitkit2
1 Medical Academic Center, Bangkok, Thailand
2 Department of Community Medicine, Dr. DY Patil University, Pune, Maharashtra, India
|Date of Submission||17-Nov-2018|
|Date of Decision||28-Jan-2019|
|Date of Acceptance||31-Jan-2019|
|Date of Web Publication||13-Mar-2019|
Dr. Beuy Joob
Medical Academic Center, Bangkok
Source of Support: None, Conflict of Interest: None
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 May 21];3:42-5. Available from: http://www.bmbtrj.org/text.asp?2019/3/1/42/254100
| Introduction|| |
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.,,,, The WHO presently states that there are several countries that are the important foci that are the exact problematic point for global tuberculosis control. Of 16 problematic countries proposed by WHO in 1998, many countries locate in tropical Southeast Asia region, Indochina.
In Indochina, the area between Thailand and Myanmar is presently the problematic endemic area of tuberculosis.,, 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|| |
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 and BCG coverage rate 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|| |
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|| |
Mycobacteria are a specific group of bacteria that might cause the health problem. Mycobacterial infection is still the global public health issue. 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. 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. 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. Shete et al. noted that the concept for management of the tuberculosis for this specific group was not different from that for other groups. 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.
The problem of tuberculosis at international border area in developing zone of Asia still presently exists., 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.,, 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. Up to 22.5% of the tuberculosis treatment result in this area are considered failures. 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.
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. 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. Hasan et al. noted that BCG played important role in protection against severe forms of disease in tuberculosis high-burden area. It is proven that the BCB vaccination is a cost-effective preventive strategies against the disease.,,, 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.
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%.,, 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%. The BCG coverage observed in Thailand is better than that seen in other nearby Indochina country such as Laos (about 82.2%–88.3%). In Laos, the poverty is the main barrier for access to BCG vaccination. 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. The similar problem of BCG coverage in rural village is also reported.
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. 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. Flaherty et al. also reported a similar phenomenon. Flaherty et al. noted for the requirement for development of new vaccine for using in a specific regions with elevated levels of environmental mycobacteria. 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. 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|| |
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
Conflicts of interest
There are no conflicts of interest.
| References|| |
Cormier M, Schwartzman K, N'Diaye DS, Boone CE, Dos Santos AM, Gaspar J, et al.
Proximate determinants of tuberculosis in indigenous peoples worldwide: A systematic review. Lancet Glob Health 2019;7:e68-80.
Standley C, Boyce MR, Klineberg A, Essix G, Katz R. Organization of oversight for integrated control of neglected tropical diseases within ministries of health. PLoS Negl Trop Dis 2018;12:e0006929.
Getahun H, Matteelli A, Abubakar I, Aziz MA, Baddeley A, Barreira D, et al.
Management of latent Mycobacterium tuberculosis
infection: WHO guidelines for low tuberculosis burden countries. Eur Respir J 2015;46:1563-76.
Prasad A, Ross A, Rosenberg P, Dye C. A world of cities and the end of TB. Trans R Soc Trop Med Hyg 2016;110:151-2.
Bishwajit G, Ide S, Ghosh S. Social determinants of infectious diseases in South Asia. Int Sch Res Notices 2014;2014:135243.
Wise J. WHO identifies 16 countries struggling to control tuberculosis. BMJ 1998;316:957.
Tschirhart N, Nosten F, Foster AM. Migrant tuberculosis patient needs and health system response along the Thailand-Myanmar border. Health Policy Plan 2017;32:1212-9.
Tschirhart N, Sein T, Nosten F, Foster AM. Migrant and refugee patient perspectives on travel and tuberculosis along the Thailand-Myanmar border: A Qualitative study. PLoS One 2016;11:e0160222.
Minetti A, Camelique O, Hsa Thaw K, Thi S, Swaddiwudhipong W, Hewison C, et al.
Tuberculosis treatment in a refugee and migrant population: 20 years of experience on the Thai-Burmese border. Int J Tuberc Lung Dis 2010;14:1589-95.
Sirinavin S, Chotpitayasunondh T, Suwanjutha S, Sunakorn P, Chantarojanasiri T. Protective efficacy of neonatal bacillus Calmette-Guérin vaccination against tuberculosis. Pediatr Infect Dis J 1991;10:359-65.
Kaji A, Parker DM, Chu CS, Thayatkawin W, Suelaor J, Charatrueangrongkun R, et al.
Immunization coverage in migrant school children along the Thailand-Myanmar border. J Immigr Minor Health 2016;18:1038-45.
Stanford J, Stanford C. Mycobacteria and their world. Int J Mycobacteriol 2012;1:3-12. [Full text]
Schram A, Ruckert A, VanDuzer JA, Friel S, Gleeson D, Thow AM, et al.
Aconceptual framework for investigating the impacts of international trade and investment agreements on noncommunicable disease risk factors. Health Policy Plan 2018;33:123-36.
Selvey LA, Antão C, Hall R. Entry screening for infectious diseases in humans. Emerg Infect Dis 2015;21:197-201.
Shete PB, Boccia D, Dhavan P, Gebreselassie N, Lönnroth K, Marks S, et al.
Defining a migrant-inclusive tuberculosis research agenda to end TB. Int J Tuberc Lung Dis 2018;22:835-43.
Maltezou HC, Elhadad D, Glikman D. Monitoring and managing antibiotic resistance in refugee children. Expert Rev Anti Infect Ther 2017;15:1015-25.
Apidechkul T. A 20-year retrospective cohort study of TB infection among the hill-tribe HIV/AIDS populations, Thailand. BMC Infect Dis 2016;16:72.
Heifets LB, Cangelosi GA. Drug susceptibility testing of Mycobacterium tuberculosis
: A neglected problem at the turn of the century. Int J Tuberc Lung Dis 1999;3:564-81.
Thi SS, Parker DM, Swe LL, Pukrittayakamee S, Ling CL, Amornpaisarnloet K, et al.
Migration histories of multidrug-resistant tuberculosis patients from the Thailand-Myanmar border, 2012-2014. Int J Tuberc Lung Dis 2017;21:753-8.
Hemhongsa P, Tasaneeyapan T, Swaddiwudhipong W, Danyuttapolchai J, Pisuttakoon K, Rienthong S, et al.
TB, HIV-associated TB and multidrug-resistant TB on Thailand's border with Myanmar, 2006-2007. Trop Med Int Health 2008;13:1288-96.
Tschirhart N, Thi SS, Swe LL, Nosten F, Foster AM. Treating the invisible: Gaps and opportunities for enhanced TB control along the Thailand-Myanmar border. BMC Health Serv Res 2017;17:29.
Myint TT, Win H, Aye HH, Kyaw-Mint TO. Case-control study on evaluation of BCG vaccination of newborn in Rangoon, Burma. Ann Trop Paediatr 1987;7:159-66.
Hasan Z, Irfan M, Khan JA, Jahangir SK, Haris M, Ashraf M, et al.
BCG vaccination is associated with decreased severity of tuberculosis in Pakistan. Int J Mycobacteriol 2012;1:201-6. [Full text]
Tu HA, Vu HD, Rozenbaum MH, Woerdenbag HJ, Postma MJ. A review of the literature on the economics of vaccination against TB. Expert Rev Vaccines 2012;11:303-17.
Abubakar I, Pimpin L, Ariti C, Beynon R, Mangtani P, Sterne JA, et al.
Systematic review and meta-analysis of the current evidence on the duration of protection by bacillusCalmette-Guérin vaccination against tuberculosis. Health Technol Assess 2013;17:1-372, v-vi.
Castelo A, Mathiasi PA, Iunes R, Kritski AL, Dalcolmo M, Fiuza de Melo F, et al.
Cost effectiveness of antituberculosis interventions. Pharmacoeconomics 1995;8:385-99.
Mori T, Uchimura K. Some topics of TB research using epidemetric models. Kekkaku 2008;83:803-9.
Phonboon K, Ramaboot S, Kunasol P, Preuksaraj S. Thailand expanded program on immunization: A ten-years review of coverage and impact on EPI target diseases. Southeast Asian J Trop Med Public Health 1989;20:529-40.
Chunsuttiwat S, Biggs BA, Maynard J, Thamapalo S, Laoboripat S, Bovornsin S, et al.
Integration of hepatitis B vaccination into the expanded programme on immunization in Chonburi and Chiangmai provinces, Thailand. Vaccine 1997;15:769-74.
Srilerdfa K, Srisamut N, Maiwai Y. Comparative health survey of Luangpraot-Tanlium and Marialai communities Lat Krabang district, Bangkok. J Med Assoc Thai 2003;86:802-8.
Phoummalaysith B, Yamamoto E, Xeuatvongsa A, Louangpradith V, Keohavong B, Saw YM, et al.
Factors associated with routine immunization coverage of children under one year old in Lao people's democratic republic. Vaccine 2018;36:2666-72.
Ngy MH, Nakamura K, Ohnishi M, Kizuki M, Suyama S, Seino K, et al.
Improved perinatal health through qualified antenatal care in urban Phnom Penh, Cambodia. Environ Health Prev Med 2007;12:193-201.
Main B, Lower T, James R, Rouse I. Changes in expanded program for immunization coverage for mother and child in Krakor, Cambodia 1996–1998. Trop Med Int Health 2001;6:526-8.
Kaewkungwal J, Apidechkul T, Jandee K, Khamsiriwatchara A, Lawpoolsri S, Sawang S, et al.
Application of mobile technology for improving expanded program on immunization among highland minority and stateless populations in Northern Thailand border. JMIR Mhealth Uhealth 2015;3:e4.
Parkash O. How to avoid the impact of environmental mycobacteria towards the efficacy of BCG vaccination against tuberculosis? Int J Mycobacteriol 2014;3:1-4. [Full text]
Flaherty DK, Vesosky B, Beamer GL, Stromberg P, Turner J. Exposure to Mycobacterium avium
can modulate established immunity against Mycobacterium tuberculosis
infection generated by Mycobacterium bovis
BCG vaccination. J Leukoc Biol 2006;80:1262-71.