Population-Based Study of Streptococcus suis Infection in Humans in Phayao Province in Northern Thailand

BACKGROUND: Streptococcus suis infection in humans has received increasing worldwide recognition. METHODS AND FINDINGS: A prospective study of S. suis infection in humans was conducted in Phayao Province in northern Thailand to determine the incidence and the risk behaviors of the disease in this region in 2010. Thirty-one cases were confirmed. The case fatality rate was 16.1%, and the estimated incidence rate was 6.2 per 100,000 in the general population. The peak incidence occurred in May. The median age of the patients was 53 years and 64.5% were men. Consumption of raw pork products was confirmed in 22 cases and the median incubation period (range) was 2 days (0-11) after consumption of raw pork products. Isolates from 31 patients were confirmed as serotype 2 in 23 patients (74.2%) and serotype 14 in eight patients (25.8%). The major sequence types (STs) were ST1 (n = 20) for serotype 2 and ST105 (n = 8) for serotype 14. The epidemiological analysis suggested three possible clusters, which included 17 cases. In the largest possible cluster of 10 cases in Chiang Kham and its neighboring districts in May, the source of infection in four cases was identified as a raw pork dish served at the same restaurant in this district. Microbiological analysis confirmed that three of four cases associated with consumption of raw pork at this restaurant were attributable to an identical strain of serotype 2 with ST1 and pulsotype A2. CONCLUSIONS: Our data suggest a high incidence rate of S. suis infection in the general population in Phayao Province in 2010 and confirm a cluster of three cases in 31 human cases. Food safety control should be strengthened especially for raw pork products in northern Thailand

Monthly distribution of human cases of <i>Streptococcus suis</i> infection in each district in Phayao Province in 2010.

<p>Monthly distribution of human cases of <i>Streptococcus suis</i> infection in each district in Phayao Province in 2010.</p

Clinical, epidemiological and microbiological features of 31 human cases of <i>Streptococcus suis</i> infection in Phayao Province, 2010.

<p>Three possible clusters in the district of Muang Phayao (PC I), the districts of Chiang Kham, Chun and Pong (PC II), and the districts of Dok Khantai and Chun (PC III) are shown.</p><p>*The pulsotype was designated as previously described <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0031265#pone.0031265-Kerdsin1" target="_blank">[4]</a>. A2^**, Serotype 2 with pulsotype A2 was the causative pathogen of a cluster of three cases. MLST, multilocus sequence type; ST, sequence typing.</p