Reducing Fatalities from Box Jellyfish Stings: Lessons from a Decade-long of Surveillance Study in Surat Thani Province, Thailand

Abstract Background: From 2016 to 2021, Thailand reported no toxic jellyfish deaths until one fatality on Pha-ngan Island. Aims: This study aimed to characterize envenomation incidents caused by toxic jellyfish in the Samui and Pha-ngan districts of Surat thani Province between 2015 and 2024 and to examine potential risk factors associated with fatal outcomes. Methods and Material: The research team established the Toxic Jellyfish Networks in 2008, followed by the implementation of a national toxic jellyfish surveillance system in 2009. These initiatives involved recruiting personnel, conducting case investigations (conducted by trained personnel), carrying out research, educating public health, and implementing intervention measures. The study included only cases that sought medical attention at hospitals within both districts. Data collection included demographic characteristics, details of the envenomation incident, clinical manifestations, treatment outcomes at the time of discharge. No personal information was included in the analysis file. Results: Among the 87 cases, 53.49% were male, with a mean age of 24.34 years (standard deviation: 16.99 years). Seventy-five were classified as non-fatal, 9 as near-fatal, and 3 as fatal. The proportion of cases receiving appropriate first aid increased to 57.32%; however, incorrect first aid measures were administered in 41.67% of fatal and near-fatal cases. All 12 fatal and near-fatal cases involved stings from multiple-tentacle box jellyfish. A comparison between fatal/near-fatal and non-fatal cases revealed that clinical manifestations-including collapse or near-collapse, abnormal blood pressure, irregular heartbeat, respiratory distress, blistering or papular eruptions at the sting site, and anxiety-were associated with an increased risk of fatality (risk ratios ranged from 3.26 to 60.92). Conclusions: Mortality rates declined in the later years, suggesting that the sustained implementation of intervention measures may have contributed to improved outcomes. The findings are useful for enhancing risk communication, public education, and training programs to mitigate the adverse effects of toxic jellyfish envenomation.