Letter from Thailand

The Thoracic Society of Thailand under Royal Patronage held their annual scientific conference from 17 to 19 February 2022 in the city of Pattaya, Thailand. The theme was ‘The New Horizon in Pulmonary Medicine’. It was a hybrid meeting with over 300 onsite participants and another 500 online participants. There was also the Annual General Meeting and election of the new Executive Committee. Associate Professor Jamsak Tscheikuna from the Faculty of Medicine Siriraj Hospital, was elected to be the new President. He and his team will run the society for the next 2 years and reassured members that he will follow the policies of the outgoing President (Associate Professor Nitipatana Chierakul), especially advocacy policies on coronavirus disease 2019 (COVID-19), PM 2.5 (particulate matter with diameter of 2.5 micrometres or less) and tuberculosis (TB), with the government and related agencies. Thailand has a high burden of TB. According to the World Health Organization (WHO) Global Tuberculosis Report 2021,1 the TB incidence in Thailand is 1.3 times the global rate. Reported diagnosis stands at only 59% of the expected total number of cases. This partly reflects a delay in or lack of access to treatment that leads to spread in the community. As a result, projections of TB cases reduce slowly. In 2015, WHO released a global list of high-burden countries for TB, which include (1) high TB burden countries, (2) high TB–HIV burden countries and (3) high multidrug-resistant and rifampicin-resistant TB (MDR/RR-TB) burden countries. In 2015, Thailand was placed in all three of the global lists. In 2021, WHO released a new set of global lists of high-burden countries for TB. Thailand has transitioned out of the list of countries with high MDR/RR-TB for the first time. There are many other successful stories. TB incidence has declined by more than 10% between 2017 and 2020; WHO estimates that Thailand has a TB incidence of 150 per 100,000 populations (105,000 annual cases), and 11,000 deaths of TB per year. Of the annual TB cases, 9900 were estimated to also be HIV positive. The treatment success rate was 85% of new or relapsed TB cases.1 The incidence of MDR/RR-TB was estimated at 3.6 per 100,000 population or 2500 cases. The shorter course with a 9–11-month regimen for MDR/RR-TB, which was launched in Thailand in 2018, was indicated as a major factor for the increasing success rate of MDR/RR-TB treatment. Thailand is still in the list of the 30 countries with both a high TB burden and high TB/HIV burden. Thailand has implemented the policy of TB screening among high-risk groups, for example household contacts, diabetic patients, elderly people, migrant workers, healthcare workers, prisoners and patients with HIV. Rapid molecular testing (real-time PCR Mycobacterium TB/MDR) has been implemented for the diagnosis of active cases. The Ministry of Public Health implemented the policy for TB screening among inmates in all prisons in Thailand since 2017. All prisoners have access to chest x-rays for TB screening. More TB cases were detected and the treatment success rate among prisoners was 83.9%–93.1%. Regarding TB/HIV co-infections, 83.1%–88.5% of TB cases were tested for HIV. The HIV-positive results declined from 10.9% to 9.4%. TB/HIV cases who have received antiretroviral drugs during TB treatment increased from 66.6% to 84.5%.2 The Department of Disease Control, under the Ministry of Public Health, through the Division of Tuberculosis, will continue its commitment to collaborate with all levels of partners and stakeholders—both public and private—to achieve the goal of reducing TB incidence. The ultimate goal is to eventually transition out of the global lists of high-burden countries, as well as to achieve the Third Sustainable Development Goal which leads to the End TB target by the year 2035 and a sustained ‘TB-free Thailand’ (Figure 1). This letter could not be finished without mentioning the COVID-19 situation in Thailand. The COVID-19 pandemic has impacted healthcare management around the world, but Thailand as a country passed the worst of the situation reasonably well. The Thai Government set up the ‘Centre for the Administration of the Situation due to the Outbreak of the Communicable Disease Coronavirus (COVID-19)’ chaired by the Prime Minister of Thailand himself to facilitate co-operation between different agencies (e.g., the Ministry of Public Health and Ministry of Interior, among others). The coronavirus outbreak was confirmed in Thailand on 13 January 2020. According to the Department of Disease Control, Ministry of Public Health, Thailand has recorded a total of 3,226,697 cases (as of 24 May 2022), equivalent to 6411 cases/100,000 population. There has been 23,851 deaths, equivalent to 43 deaths/100,000 population. In the same timeframe, there were 460,214,272 cases globally with 6,067,716 deaths.3 The recent decline in active cases as well as reduction in severity are likely the result of active COVID-19 immunization. As of 22 May 2022, the first dose of vaccine has been administered to 84% of the population, with the second dose administered to 77.7% of the population. Globally, these numbers are 65.9% and 60.0%, respectively.4 The third booster dose has been given to 39.2% of the population. Currently, the vaccination rate in Thailand is in the range of 100,000–200,000 doses per day. In the near future, the COVID-19 pandemic will become an endemic disease in Thailand. Respiratory physicians and academics should familiarize themselves with scientific data and information on the long-term effects of COVID-19 infections, known as Long COVID, especially on the respiratory system. None declared.