Background: The incidence of acute diarrhea in Thai children under five years of age has increased over the last three decades. Even though mortality has significantly declined, the burden and cost of medical treatment are still high. Our objectives are to describe the burden and pattern of acute diarrhea cases that required admissions by Thai children under five years of age from 2015 to 2019. Methods: Data regarding the admission of acute diarrhea cases of Thai children with Thailand National Health Coverage (NHC) under five years of age from 2015 to 2019, recorded as International Statistical Classification of Diseases and Related Health Problems, tenth Revision, Thai Modification (ICD-10-TM), were analyzed. Results: The incidence trend of yearly acute diarrhea in children 0–5 years of age slightly increased from 33.36 cases per 1,000 population in 2010 to an average of 33.79 cases per 1,000 population/ year from 2015 to 2019 or approximately 0.43 cases per 1,000 population over the last decade while diarrhea-related mortality had a low, constant rate of 0.71 to 1.16 per 100,000 population per year. Two thirds of the mortality rate was observed in children under 1 year of age or 4.1 cases per 100,000 person-years in 5-year period (P < 0.01). The high cost of performing the medical treatment of approximately four hundred million baht per year. Seasonal variations demonstrated consistency with similar patterns during the cold and rainy seasons throughout the 5-year period. Regional distribution of the causative agent was also observed in Cholera, Typhoid, and Amoebiasis cases. A08: viral and other specified intestinal infections and A09: other gastroenteritis and colitis of infectious and unspecified origin were the two most common causes of diarrheal diseases. Conclusions: The incidence rate of acute diarrhea in Thai children under five years of age was higher while the mortality rate of acute diarrhea was lower than those in the past decade. A similar seasonal outbreak of acute diarrhea was seen during each examined year. The causative agent was not significant and was mainly unspecific. Trial registration: Number TCTR20220117002, date of registration: 17/01/2022, site: Thai Clinical Trials Registry, URL http://www.thaiclinicaltrials.org/show/TCTR20220117002

Background: Two types of rotavirus vaccines (RVs), Rotarix (RV1) and RotaTeq (RV5), were licensed as optional vaccines in 2012 and became part of the National Immunization Program (NIP) in the fiscal year 2020 in Thailand. The main objective was to evaluate the impact of rotavirus vaccines on the burden of acute diarrheal severity ranging from outpatient visits, diarrheal-related admission or deaths in the pre-NIP period (fiscal year 2015–2019) and in the fiscal year 2020. The minor objectives were assessed on the monthly admission rate, rotavirus vaccine coverage rate and rotavirus vaccine completed dose (RotaC). Methods: Data regarding OPD, admission, and death cases under the Thailand National Health Coverage (NHC) from fiscal year 2015–2020, which were recorded as International Classification of Diseases and Related Health Problem 10^th (ICD-10), were analyzed. Results: The burden of diarrheal-related disease diminished after the rotavirus vaccine was introduced in the fiscal year 2020 when compared to the previous 5 fiscal years. The OPD visit rate decreased from 10.1 to 8.3 visits per 100 person-years (P < 0.001), or a 17.8% reduction (incidence rate ratio (IRR) = 0.82; 95% confidence interval (CI): 0.81 to 0.82). The admission rate significantly declined from 31.4 to 30.5 cases per 1,000 person-years, (P < 0.001), or a 2.9% reduction (IRR = 0.97; 95% CI: 0.96 to 0.98). The diarrheal-related mortality rate also subsided from 10.2 to 8.1 cases per 100,000 person-years (P 0.3), or a 20.0% reduction (IRR = 0.88; 95% CI: 0.50 to 1.22). The major population in both admissions and deaths was infants under 1 year of age (P < 0.001). Seasonality was seen as a constant bimodal pattern, with a significant decrease in monthly admissions after 6 months of rotavirus vaccine introduction to NIP (P < 0.001). RotaC was 37.4% in the first year of NIP. Conclusions: The rotavirus vaccine had a potential benefit for reducing the diarrheal disease burden, especially in infants under one year of age. Seasonality outbreaks of acute diarrhea subsided after the rotavirus vaccine was introduced. The RotaC was fairly low in the first year of the NIP. The quality of the rotavirus vaccine should be warranted. Trial registration: Number TCTR20220120003, date of registration: 20/01/2022, site: Thai Clinical Trials Registry.

Background/Aims: The coronavirus disease (COVID)-19 pandemic presents challenges for gastrointestinal endoscopy. Although the virus is transmitted through contact and droplets, aerosol-generating procedures produce aerosols that can spread through airborne routes. Several gastrointestinal societies have released statements to protect patients and health care providers (HCPs). This study describes a barrier box that may be used as an adjunctive device in addition to personal protective equipment during endoscopies.Methods: A transparent acrylic box called “Endoshield” was created to place over patient’s head and shoulders and was tested for its ease of use for the endoscopist and suitability for patient size and position.Results: Twelve children (66.67%, male) with a median age of 9 years (range, 2–11 years) underwent emergency or urgent endoscopy between April and June 2020 during the COVID-19 outbreak. The most common presenting symptom was life-threatening gastrointestinal bleeding (8/12, 66.67%), while the rest had urgent symptoms (4/12, 33.33%). The “Endoshield” was suitable for all patient positions (left lateral position: 9/12, 75% and supine position: 3/12, 25%). The patients and HCPs were followed up for their symptoms on day 14, and none of them had any symptoms of concern.Conclusions: The “Endoshield” is affordable, reusable, and suitable for both positions.

Background: The incidence of acute diarrhea in Thai children under five years of age has increased over the last three decades. Even though mortality has significantly declined, the burden and cost of medical treatment are still high. Our objectives are to describe the burden and pattern of acute diarrhea cases that required admissions by Thai children under five years of age from 2015 to 2019.Methods: Data regarding the admission of acute diarrhea cases of Thai children with Thailand National Health Coverage (NHC) under five years of age from 2015 to 2019, recorded as International Statistical Classification of Diseases and Related Health Problems, tenth Revision, Thai Modification (ICD-10-TM), were analyzed.Results: The incidence trend of yearly acute diarrhea in children 0-5 years of age slightly decreased over approximately the last decade (124,403 cases in 2010 to 102,941 cases from 2015 to 2019), along with the high cost of performing the medical treatment of approximately three billion baths per year. Diarrhea-related mortality had a low, constant rate of 0.95 per 100,000 population per year (range: 0.81-1.14 per 100,000 population per year). Three-fourths of the mortality rate was observed in children under 2 years of age and a regional distribution of the causative agent was also observed in Cholera, Typhoid, and Amoebiasis cases. Seasonal variations demonstrated consistency with similar patterns during the cold and rainy seasons throughout the 5-year period. A08 and A09 were the two most common causes of diarrheal diseases.Conclusions: The burden, incidence and mortality rate of acute diarrhea in Thai children under five years of age were lower than those in the past decades. A similar seasonal outbreak of acute diarrhea was seen during each examined year. The causative agent was not significant and was mainly unspecific.Trial registration: number TCTR20220117002, date of registration 17/01/2022

Background: The national data on the burdens of pancreatic diseases in children are lacking. Methods: We analyzed hospitalized patients aged <18 years under the Universal Health Scheme according to Thailand’s National Health Security Office’s data from 2015 to 2023. Results: Pancreatic diseases had a mean (SD) admission number of 212.3 (28.4) per year or 22 (3) per 100,000 admissions of all inpatient diagnoses. The admission numbers significantly upsurged in the following diagnoses: acute pancreatitis (AP) (K85) (average annual percent change, AAPC: 4.7; 95%CI:2.2 to 6.4); biliary AP (K85.1) (AAPC:6.8; 95%CI:0.3 to 13.8); and other chronic pancreatitis (CP) (K86.1) (AAPC: 9.1; 95%CI:1.5 to 17.1). The overall inpatient mortality of pancreatic diseases was 10.1 (IQR: 5.4, 10.3) per 1,000 admissions, significantly higher than all inpatient diagnoses ( P =0.04). The mean (SD) total payment for pancreatic diseases was 12,067,400 (3,342,746) THB or 375,347 (103,973) USD per year, accounting for 3.6% of all inpatient diagnoses. The payment had been rising for CP (AAPC: 12.73; 95%CI: 2.4 to 24.4) and pancreatic pseudocyst (AAPC: 12.1; 95%CI:2.4 to 23.1). Other diseases of pancreas, reported greater rates of endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography (OR:4.96; 95%CI:3.21 to 7.66, and OR:2.03; 95%CI:1.39 to 2.97, respectively) when compared to AP. Endoscopic procedures concerning the pancreatic duct were increasingly performed in children (AAPC:16.7; 95%CI:13.3 to 20.3). Conclusions: Pancreatic diseases in children that required hospitalization have a growing incidence with rising health care expenditure and intervention trends. Although the number of admissions is not high, the diseases exhibit high inpatient mortality rate.

Prachuapthunyachart S, et al. Pediatr Gastroenterol Hepatol Nutr. 2026 Sep;29(5):390-400. https://doi.org/10.5223/pghn.2026.29.5.390