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การเกิดซ้ำของโรคที่สามารถป้องกันด้วยวัคซีนในประเทศไทย: กรณีศึกษาของโรคคอตีบ โรคหัด โรคหัดเยอรมัน และโรคไวรัสตับอักเสบชนิดเอ

อรุณรักษ์ คูเปอร์ มีใย; โสภณ เอี่ยมศิริถาวร; จักรรัฐ พิทยาวงศ์อานนท์; ปณิธี ธัมมวิจยะ; สมคิด คงอยู่; วิริชดา ปานงาม; ปิยะ หาญวรวงศ์ชัย; วิราวรรณ ชินวิริยสิทธิ์; เศรษฐภัทร ชินวิริยสิทธิ์; ธีระพล สลีวงศ์; วรรณพงษ์ เตรียมโพธิ์; ชรินทร์ โหมดชัง;
Date: 2560-03-02
Abstract
Immunization was first practiced in Thailand in 1977 through the National Expanded Program on Immunization (EPI) with the aim of significantly reducing morbidity and mortality from common vaccine-preventable diseases. When first introduced the EPI program coverage level was very low: about 10-20 percent for many diseases. By 2000 vaccine coverage for nearly all vaccines in the EPI program was more than 90 percent. Consequently, rates of vaccine preventable diseases (such as diphtheria, measles, and rubella) in Thailand are very low. Despite high vaccine coverage in Thailand, however, there has been a resurgence of some vaccine-preventable diseases. For example, there was a resurgence of diphtheria in eight provinces in 2012, and measles outbreaks occur among children every 3-4 years. There are a few possible explanations for the return of vaccine-preventable diseases in Thailand. The first possible reason is population movement, in particular migration to Thailand. Next is low immunization coverage (below the critical threshold) in particular locations among children aged less than five years old. The other possible reason for the resurgence is waning immunity in adults. An evaluation of these possible reasons for the resurgences would help us to identify effective measures to protect against a return of vaccine preventable diseases in Thailand. During the period (2012) of the diphtheria outbreak, Bueng-Kan which is located at the border between Thailand and the Lao People's Democratic Republic, there was an outbreak of hepatitis A with a case rate of 355 per 100,000. Investigation of this outbreak suggested that contaminated water and ice were sources of infection. During the past decade Thailand has faced several major outbreaks of hepatitis A, which resulted in thousands of infected people and hundreds of hospitalizations. Currently, the hepatitis vaccine is not included in the EPI program. There are more than 3.5 million persons without Thai nationality living in the country, including many long-term residents and children of migrants born in Thailand. The approximately 3.1 million migrants working in Thailand comprise about 8 per cent of the labour force. Because of Thailand’s relative economic and social stability, it is a primary destination for many regional worker migrants. Those migrants are vulnerable to health risks due to limited or inadequate access to basic health services and poor living conditions. However, there is little or no data on the immunization coverage of this group as well as on their movement inside Thailand.The resurgence of vaccine preventable diseases in some parts in Thailand raises the following questions. What are the reasons for these resurgences? Will the epidemics of these diseases expand to others part of Thailand? How can they be controlled? Is Thailand sufficiently protected against a return of vaccine preventable diseases such as diphtheria, measles, rubella, and hepatitis A? In order to gain insights into the resurgence of vaccine preventable diseases in Thailand, this project propose to: 1) explore the epidemiology and dynamics of the resurgence of vaccine preventable disease epidemics in Thailand; 2) determine the seroprevalence of vaccine preventable diseases among migrant populations in Thailand; 3) determine contact and movement patterns of migrant populations in Thailand; 4) use mathematical models to demonstrate possible scenarios for the spread of vaccine preventable diseases among migrants and Thai nationals taking into account the effect of population movement patterns and to suggest optimal control strategies; 5) use mathematical models to evaluate the spatial dimension of vaccine preventable disease spread among migrants and the Thai population; and 6) determine the cost-effectiveness of implementing vaccination campaigns for the migrant population in Thailand. The end result of the whole project will be an evidence base which can be practically used by the public health sector for epidemic mitigation, prevention and control.
Copyright ผลงานวิชาการเหล่านี้เป็นลิขสิทธิ์ของสถาบันวิจัยระบบสาธารณสุข หากมีการนำไปใช้อ้างอิง โปรดอ้างถึงสถาบันวิจัยระบบสาธารณสุข ในฐานะเจ้าของลิขสิทธิ์ตามพระราชบัญญัติสงวนลิขสิทธิ์สำหรับการนำงานวิจัยไปใช้ประโยชน์ในเชิงพาณิชย์
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HSRI Knowledge BankDashboardCommunities & CollectionsBy Issue DateAuthorsTitlesSubjectsThis CollectionBy Issue DateAuthorsTitlesSubjectsSubjectsการบริการสุขภาพ (Health Service Delivery) [619]กำลังคนด้านสุขภาพ (Health Workforce) [99]ระบบสารสนเทศด้านสุขภาพ (Health Information Systems) [286]ผลิตภัณฑ์ วัคซีน และเทคโนโลยีทางการแพทย์ (Medical Products, Vaccines and Technologies) [125]ระบบการเงินการคลังด้านสุขภาพ (Health Systems Financing) [158]ภาวะผู้นำและการอภิบาล (Leadership and Governance) [1281]ปัจจัยสังคมกำหนดสุขภาพ (Social Determinants of Health: SDH) [228]วิจัยระบบสุขภาพ (Health System Research) [28]ระบบวิจัยสุขภาพ (Health Research System) [20]

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