Safeguarding Thai Communities: Tackling H. pylori Risks through Foodborne Surveillance and Public Engagement

By Assoc. Prof. Dr. Chonticha Romyasamit and Team 

Editor: Anti Rismayanti, SEAOHUN Regional Program Manager 

In the bustling local markets of Thailand, where food stalls brim with vibrant produce and freshly ground meats, a silent threat may lurk unnoticed—Helicobacter pylori (H. pylori), a bacterium implicated in severe gastrointestinal diseases, including peptic ulcers and gastric cancer. With growing concerns about antimicrobial resistance (AMR) and foodborne transmission, a multidisciplinary team led by Assoc. Prof. Dr. Chonticha Romyasamit of Walailak University embarked on an ambitious study under the SEAOHUN Transition Award (TA) through the 2024 One Health Research and Training (OHRT) Awards Program. Their mission: to investigate the prevalence, resistance patterns, and genetic traits of H. pylori in minced meat and raw vegetables sold in Thai markets—and in doing so, promote safer food handling practices across communities.

From Market to Microscope: Detecting a Foodborne Threat

Between May and September 2024, the team collected and analyzed a total of 550 food samples, comprising 110 minced meat and 440 raw vegetable samples sourced from local retail markets. Employing MALDI-TOF MS (Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry), the researchers identified five H. pylori isolates—a notable finding given the general perception that H. pylori transmission is primarily person-to-person or via water sources.

Antibiotic susceptibility testing revealed alarming resistance trends, with the isolates showing resilience to commonly used antibiotics such as ampicillin, penicillin, and trimethoprim-sulfamethoxazole. These results not only raise concerns about treatment efficacy but also highlight the potential for antibiotic misuse in agricultural or food preparation settings.

To further understand the potential severity of these strains, the team conducted genotyping to detect virulence-associated alleles like cagA and vacA. Interestingly, none of the isolates possessed these genes, suggesting a possibly lower pathogenic profile in these specific strains. However, the team notes that other virulence markers may be at play, and further genomic studies are planned.

Empowering the Public: Education as Prevention

Beyond laboratory analysis, the project embraced a One Health approach by prioritizing public awareness and behavior change. The team developed visually engaging infographics detailing how H. pylori spreads and how to reduce transmission risks through proper food hygiene. These materials were disseminated online, paired with a questionnaire that garnered 115 responses from consumers and community members.

The survey revealed some promising trends:

84% of respondents were aware of H. pylori, largely informed by healthcare professionals.

98% reported washing hands before and after handling food.

97% stated they consistently cook meat thoroughly.

However, the data also highlighted critical gaps in food safety practices. Only 25% used separate cutting boards for meat and vegetables—a key factor in preventing cross-contamination. Moreover, 68% admitted to occasionally consuming raw or undercooked meat or vegetables, echoing cultural norms that may heighten infection risks.

Public receptivity to health promotion was overwhelmingly positive, with 98% supporting further campaigns. This underscores a strong potential for long-term behavioral change when equipped with the right tools and knowledge.

Navigating Challenges and Strengthening Collaboration

Like many field-based studies, this project faced its share of challenges. Coordinating sample collection across diverse markets involved complex logistics, and laboratory resource constraints necessitated careful equipment management and adaptive planning. Still, the project’s success is owed in large part to robust partnerships—with academic institutions, local market vendors, and public health agencies.

The team’s collaborative structure, which brought together researchers from Thailand and Indonesia, facilitated interdisciplinary problem-solving and knowledge exchange. Regular consultations with local health authorities also ensured that the research aligned with national public health priorities.

Outcomes and the Road Ahead

The outcomes of this research have already begun to make a tangible impact, with findings being considered in the context of strengthening public health guidelines, particularly those related to foodborne antimicrobial resistance (AMR) surveillance and prevention strategies. The revelation that H. pylori can be isolated from common food sources such as minced meat and raw vegetables has sparked a sense of urgency among local health authorities and food safety regulators. These findings serve as a wake-up call that food handling practices must be addressed as a critical front in the battle against AMR and infection risks.

At the community level, the educational infographics and awareness campaigns initiated by the project have created a ripple effect. Not only have they encouraged households to reconsider their own kitchen habits, but they have also prompted dialogue within educational institutions, health departments, and local governance structures about the broader implications of foodborne pathogens. Discussions are now underway about how to institutionalize better food safety practices, and how to leverage public education to drive meaningful behavior change.

Building on this momentum, the team plans to broaden their genotyping efforts, moving beyond the commonly studied cagA and vacA genes to explore a wider array of H. pylori virulence factors. By delving deeper into the genetic makeup of these isolates, they hope to better understand the pathogen’s potential impact on human health, particularly in the context of strains that may not present with traditional virulence markers but still pose significant risks.

Geographically, the project will expand its scope across more provinces and markets in Thailand. A broader and more representative sampling of food products will enhance epidemiological accuracy and provide insights into regional differences in contamination rates, resistance patterns, and consumer behaviors.

On the educational front, the next phase will scale up outreach campaigns. Recognizing that infographics alone are not enough, the team envisions a dual strategy: community-based workshops that provide hands-on demonstrations of safe food preparation, and digital platforms to reach broader audiences with multimedia content tailored to local languages and cultural practices. These campaigns aim not only to raise awareness but also to embed new habits that reduce infection risks.

Simultaneously, the team is committed to advocating for integrated policy approaches that connect the dots between food safety, AMR monitoring, and public engagement. Their goal is to influence policymaking by demonstrating that One Health is not a theoretical framework, but a practical strategy with real-world benefits for community health and national preparedness.

To ensure that the impact of their work endures, the team is developing a monitoring and evaluation framework to track behavioral shifts, knowledge retention, and policy uptake over time. This framework will help determine whether awareness campaigns translate into sustained improvements in hygiene and food handling—and will guide future interventions as they scale the model across different regions and contexts. Ultimately, the team sees this project not as a standalone event, but as the beginning of a long-term, systemic transformation in how food safety and zoonotic disease prevention are approached in Thailand.

Reflections and Recommendations

Reflecting on their journey, Dr. Chonticha and her team commend the SEAOHUN OHRT Awards Program for providing the necessary support to explore an under-investigated health threat. The project not only expanded the team’s technical and community engagement skills, but also enhanced their capacity to translate scientific findings into actionable strategies.

Recommendations moving forward include conducting more frequent community workshops with hands-on demonstrations, increasing collaboration with public health stakeholders, and strengthening logistics for sample collection and testing.

Conclusion

This project underscores the vital connection between human health, food practices, and microbial threats in the environment. By addressing the transmission of H. pylori through an integrated One Health lens, the team has set a precedent for multidisciplinary public health research that is both scientifically rigorous and socially impactful.

Through a combination of field research, lab analysis, and community outreach, Dr. Chonticha’s team has laid a foundation for preventing foodborne infections and promoting a safer, healthier Thailand.

Team Leader: Assoc. Prof. Dr. Chonticha Romyasamit, Walailak University, Thailand

Team Members:

• Dechawat Wongprot, Walailak University, Thailand

• Phoomjai Sorsenee, Prince of Songkla University, Thailand

• Tachpon Techarang, Mahidol University, Thailand

• Holipah Holipah, Brawijaya University, Indonesia