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Kerdsin, A.; Segura, M.; Fittipaldi, N.; Gottschalk, M. Human Streptococcus suis Disease in Southeast Asia. Encyclopedia. Available online: https://encyclopedia.pub/entry/22254 (accessed on 13 July 2025).
Kerdsin A, Segura M, Fittipaldi N, Gottschalk M. Human Streptococcus suis Disease in Southeast Asia. Encyclopedia. Available at: https://encyclopedia.pub/entry/22254. Accessed July 13, 2025.
Kerdsin, Anusak, Mariela Segura, Nahuel Fittipaldi, Marcelo Gottschalk. "Human Streptococcus suis Disease in Southeast Asia" Encyclopedia, https://encyclopedia.pub/entry/22254 (accessed July 13, 2025).
Kerdsin, A., Segura, M., Fittipaldi, N., & Gottschalk, M. (2022, April 25). Human Streptococcus suis Disease in Southeast Asia. In Encyclopedia. https://encyclopedia.pub/entry/22254
Kerdsin, Anusak, et al. "Human Streptococcus suis Disease in Southeast Asia." Encyclopedia. Web. 25 April, 2022.
Human Streptococcus suis Disease in Southeast Asia
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This entry is adapted from the peer-reviewed paper 10.3390/foods11091190

The public health systems of Southeast Asian countries are financially challenged by a comparatively higher incidence of human S. suis infections than other geographical areas. Efforts to improve practices in production settings, including improved meat inspection regulations, prevention of the slaughtering of non-healthy pigs, and enhanced hygiene practices at processing facilities, along with improvements in the pork supply chain, all appear promising for reducing food cross-contamination with S. suis. 

Streptococcus suis Southeast Asia raw pork dish

1. Introduction

In recent years, the number of reported human Streptococcus suis cases has substantially increased, with Southeast Asian countries leading the counts [1][2]. Traditionally regarded in industrialized countries as an occupational disease affecting workers in close contact with infected pigs or contaminated pork-derived products, the emergence of human S. suis disease in Southeast Asia has been linked to foodborne infections [1]. This important zoonotic pathogen is classified into 29 serotypes. Serotype 2 is the most frequently recovered from human infections, although human cases due to serotypes 4, 5, 7, 9, 14, 16, 21, 24, and 31 have been reported [2][3][4][5][6][7][8][9][10].

2. Human S. suis Serotypes and Sequence Types in Southeast Asia

As summarized in Table 1, knowledge of serotypes and sequence types (STs) causing human S. suis disease has mostly been generated in Thailand and Vietnam. Human S. suis isolates from Southeast Asia are more diverse in terms of both the serotypes and STs present than those in Europe and the Americas. This may be due to the higher incidence of human S. suis disease in Southeast Asia in comparison to Western countries.
Table 1. Serotypes and sequence types of human S. suis reported in Southeast Asia.
Country Serotype Clonal Complex Sequence Type Reference
Thailand 2 1 1, 11, 105, 126, 144, 298, 337 [4][5][6][7][9][11],
https://pubmlst.org/organisms/streptococcus-suis (accessed on 3 January 2022)
25 25, 102, 103, 380, 381, 395, 515, 516
28 28, 382
104 101, 104, 391, 392, 393, 512, 513, 514
233/379 233, 379, 1656
1687/1688 1687, 1688
Singleton 236
4 94 94
5 221/234 221
Singleton 181, 235
9 16 16
14 1 11, 105, 127
24 221/234 221, 234
31 221/234 221
Vietnam 2 1 1, 105, 107, 144, 159, 160, 161, 325, 326, 869, 951 [3][12],
https://pubmlst.org/organisms/streptococcus-suis (accessed on 3 January 2022)
14 1 1, 105
16   106
Indonesia 2 or 1/2 ND ND [13]
The Philippines ND ND ND [14][15]
Malaysia ND ND ND [16]
Cambodia 2 ND ND [17]
Singapore ND ND ND [18][19][20]
Laos ND ND ND [1]
ND = No data.
Reported serotypes of S. suis from humans in Southeast Asia are 2, 4, 5, 9, 14, 16, 24, and 31 [3][4][5][6][7][9][11][12]. Some of these STs, such as ST101-ST104, ST106, ST107, ST126, ST127, ST159-ST161, ST181, ST221, ST232-ST237, ST325, ST326, ST379-ST382, ST391-ST395, ST512-ST516, ST869, ST951, ST1656, ST1687, and ST1688 have so far exclusively been found in Southeast Asia (https://pubmlst.org/organisms/streptococcus-suis, accessed on 15 December 2021). The overall serotype and ST diversity among human S. suis isolates is higher in Thailand than in other countries in Southeast Asia. However, in Vietnam, CC1 has more STs than Thailand and other countries. Some STs (1, 105, 144) of serotypes 2 or 14 were found in both Thailand and Vietnam, which may indicate a higher circulation of these strains in this region.

3. Burden and Impact of S. suis Infection in Southeast Asia

The increasing number of human infections due to S. suis in Southeast Asian countries has had a major economic impact on public health systems. A study from Thailand showed that S. suis human infections in that country are responsible for an estimated loss in productivity-adjusted life years to the gross domestic product of USD 11.3 million, which equates to USD 36,033 lost per person [21]. A study in Chiang Mai (Northern Thailand) showed that the health burden measured in term of disability-adjusted life years (DALY) was estimated at 7.41 per 100,000 population [22]. Years of life lost (YLL) due to S. suis were higher in males (49 YYL) than in females (16 YYL). The economic impact of S. suis in Chiang Mai between 2013 and 2014 was, on average, THB 37,955 (GBP 759 or USD 1018) per patient. Out-of-pocket expenses for individuals and their families averaged THB 5198 (GBP 104 or USD 140) per patient [22]. In addition, another study revealed that in Vietnam, the direct cost per S. suis infection episode was USD 1635, consisting of USD 1046 and 589 for medical and non-medical costs, respectively [23], and that for the period 2011–2014, the annual direct cost was approximately USD 370,000–500,000. Importantly, the Vietnamese study reported that the indirect cost was substantially higher, reaching up to USD 2,270,000–2,880,000 and the DALY lost were in the range 1401–1866 for the period 2011–2014 [23].
Hearing loss and balance system dysfunction are the most frequently reported sequelae of patients who survive S. suis infections, which aggravate the impact of this disease on health and the quality of life of affected persons. Patients with long-term severe hearing loss paid significantly higher medical costs (USD 765) than those with non-severe impairment (USD 505) [23]. Another study from Vietnam showed significantly higher problems with mobility, self-care, performance of usual activities, and emotional impact caused by hearing impairment and dizziness [24]. Disability due to profound or complete hearing loss with vestibular dysfunction caused a burden of 397–516 DALY during 2011–2014 [23].
Another study revealed a high cost per patient associated with an S. suis serotype 2 outbreak [25]. That study investigated a large outbreak in Chiang Mai, Thailand in June–July 2008 (the second largest outbreak in Thailand). The outbreak had 32 confirmed cases, 2 probable cases, and 30 suspected cases. Per patient expenses were THB 38,370 (USD 1193). Outbreak-associated expenses are not a regular cost for hospital or public health routine functions and were mainly due to increases in antibiotics usage, medical supplies, laboratory investigations, outbreak investigations, and patient care related to patient treatment and measures taken to control the outbreak.

4. Contamination of S. suis in the Pork Supply Chain

The rise in the demand for pork and pork products has led to an increased risk of exposure to this zoonotic pathogen through contact with or consumption of meat from farms and market chains, which can impact national public health systems. High pig densities and frequent consumption of raw or undercooked pork are related to over 50% of the total human S. suis cases in Asia [26]. Understanding pig production and slaughtering and consumption practices or behaviors are critical in identifying or minimizing the risks of S. suis exposure to those working closely with pigs or pork meat, or to those consuming raw pig products.
Asymptomatic pigs, non-clinically affected at the time of slaughter, have been suggested as the primary source of S. suis introduced to slaughterhouses [27][28][29][30]. It is unknown whether some of these animals were ill just before being sent to the abattoir. Evidence from Vietnam and Thailand demonstrated that S. suis strains isolated from slaughterhouse pigs have pulse-field gel electrophoresis patterns and sequence types identical or highly related to those from diseased pigs and human isolates [28][31]. A study from Thailand revealed that the risk factors for contamination of S. suis were significantly higher in non-registered [OR (odds ratio) = 9.62, 95% CI (confidence interval) = 2.20–41.91; p value < 0.02] than in registered slaughterhouses [32]. Lack of proper identification of symptomatic and highly infective animals prior to slaughter and poor meat inspection are risk factors for the transmission of this zoonosis. In addition, access to protective equipment when handling raw pork products at slaughter points or kitchens is still limited in many rural areas in several Southeast Asian countries [26][33]. Therefore, improper slaughtering can result in S. suis contamination of pork meat, thus increasing the risk of infection to workers and consumers.
A study from Thailand showed that S. suis can contaminate the environment throughout the pig supply chain, from slaughterhouses up to retail markets [34]. Contamination of S. suis was reported on the working surfaces at slaughtering sites (20.8%), workers’ hands (16.7%), boots (16.7%), and pork meat (0.93%) [33]. Additionally, S. suis was isolated from surface swabs in pig transport trucks and from surface swabs of retail markets tables, cutting boards (but not knives), scales, and fridges [34]. Several studies from Thailand showed contamination of pork meat with S. suis [35][36]. Improper hygienic practices during carcass and pork handling may be responsible, at least in part, for the cross-contamination of carcasses, the environment, and raw pork product dishes with S. suis.

References

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Subjects: Infectious Diseases
Contributors MDPI registered users' name will be linked to their SciProfiles pages. To register with us, please refer to https://encyclopedia.pub/register :
Anusak Kerdsin
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Mariela Segura
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Nahuel Fittipaldi
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Marcelo Gottschalk
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Update Date: 27 Apr 2022
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