Journal of Health Sciences & Surveillance System

Temporal, Spatial, and Seasonal Trends of Pneumonia, Pulmonary Tuberculosis, and Influenza in Thailand: Impacts of the COVID-19 Pandemic

Document Type : Original Article

Authors

Pannawadee Singkaew 1
Prakasit Tonchoy 1
Phakinee Suta 2

1 Department of Occupational Health and Safety, School of Public Health, University of Phayao, Phayao, Thailand

2 San Klang Subdistrict Health Promoting Hospital, Chiang Rai Provincial Administrative Organization, Chiang Rai, Thailand

10.30476/jhsss.2025.107730.2088
Abstract
Background: The COVID-19 pandemic and associated non pharmaceutical interventions (NPIs) significantly disrupted respiratory disease transmission worldwide. However, comparative evidence across time, geography, and seasonality in Southeast Asia remains limited. To examine changes in incidence, spatial distribution, and seasonal patterns of pneumonia, pulmonary tuberculosis (TB), and influenza in Thailand across pre-pandemic, pandemic, and post-pandemic periods.
Methods: A retrospective longitudinal study was conducted using national surveillance data from all 77 Thai provinces (2014-2024). Monthly incidence rates were analyzed using negative binomial regression. Spatial patterns were visualized through choropleth maps and regional incidence rate ratios (IRRs). Seasonality was assessed using seasonal-trend decomposition (STL) and two-way ANOVA (Month×Period).
Results: Influenza incidence dropped sharply during 2020–2021 and rebounded over 30-fold post-pandemic (IRR_PD2=34.36, 95% CI: 24.26–48.72). Pneumonia declined by 37% in 2021 (IRR_D2=0.63, 95% CI: 0.41–0.96), and then rose significantly post-pandemic (IRR_PD2=1.97, 95% CI: 1.39–2.78). TB remained relatively stable. Influenza suppression was spatially uniform, with rebounds clustered in urban provinces. Pneumonia showed uneven regional resurgence; TB patterns remained geographically consistent. Seasonal cycles for all diseases re-emerged after the pandemic. Influenza exhibited a new mid-year peak, pneumonia aligned with rainy and winter months, and TB maintained a January–May peak.
Conclusions: The pandemic induced pathogen-specific shifts in respiratory disease dynamics in Thailand. Influenza and pneumonia showed marked suppression and atypical rebounds, while TB patterns remained steady. These findings underscore the need for adaptive surveillance, sustained TB services, and spatially responsive planning to strengthen future respiratory disease preparedness.

Highlights

Pannawadee Singkaew (Google Scholar)

Prakasit Tonchoy (Google Scholar)

Keywords

Influenza, Human
Pneumonia
Tuberculosis, Pulmonary
COVID-19
Spatial Analysis
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Journal of Health Sciences & Surveillance System
Volume 14, Issue 3
Summer 2026
Pages 264-275

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