An infection caused by a tiny parasitic flatworm called the liver fluke is one of Thailand’s major public health concerns, particularly in the Northeast and the North, where raw freshwater fish remain part of the traditional diet. It’s strongly linked to cholangiocarcinoma (CCA), a cancer of the bile duct which may occur following years of chronic inflammation in the biliary system. The deadly cancer claims over 14,000 Thai lives every year, with the country today recording the highest rate of this cancer in the world.
Young generation – a game changer in the fight against liver fluke disease
Despite consistent efforts to prevent and control infections from the parasitic worm, the problem persists. In an attempt to improve the situation, the National Health Commission Office (NHCO) has joined with the Thai Health Promotion Foundation (ThaiHealth), Khon Kaen University’s Cholangiocarcinoma Research Institute and their networks in launching a campaign to fight liver fluke disease and bile duct cancer, with a focus on the young generation. The campaign incorporates seminars at schools, colleges and universities. Delivered by medical personnel and health experts, the sessions are designed to educate students and young people about the potential dangers of consuming raw fish and undercooked fermented fish, the risks associated with such foods, prevention of infections and the importance of screening for infection and treatment.
The campaign recently organized an innovative media production contest dubbed ‘ISAN Zero OV Media Hackathon’ at Khon Kaen University to boost students’ engagement and active participation and encourage them to use their artistic talents and digital literacy skills to create work while making learning more exciting and fun.
“Students have a major role to play in how we can prevent and control liver fluke disease. They know about the infection and how it can be avoided and can use multimedia to create content that can be passed on to the family and the public,” said the NHCO’s secretary general Dr. Suthep Petchmark.
Liver flukes are parasites that can infect humans and cause liver and bile duct disease. Fluke infections of the liver caused by Opisthorchis viverrini (OV), also known as the Southeast Asia liver fluke, are prevalent in Thailand, Lao PDR, Cambodia and Vietnam. This is mainly due to an abundance of the freshwater snail host in the Lower Mekong Basin and the traditional consumption of raw or undercooked fish dishes.
“Most people lack awareness about fluke infections of the liver. Liver fluke disease develops slowly over years before noticeable symptoms appear,” Dr. Suthep said, urging the public to change their eating habits and avoid raw freshwater fish dishes and undercooked fermented fish to protect themselves from foodborne illnesses.
He is also calling on the public to educate themselves about liver fluke infections and undergo screening.
Early detection is the best prevention, he stressed.
Last month, thousands of university freshmen in Maha Sarakham tested positive for liver fluke infection, prompting local authorities to order inspections of the use of undercooked fermented fish (pla ra) at somtam shops in the northeastern provinces and stress the promotion of food safety practices.
Making learning fun and engaging
Danai Wangboonchai, manager of ThaiHealth’s Art and Culture for Health Literacy, explained that the ‘ISAN Zero OV Media Hackathon’ contest is intended to develop health literacy for liver fluke disease and bile duct cancer among high-school and university students through folk art and media.
“Students can use the knowledge they learned from the seminar as well as their artistic skills to create a scene that helps people understand what liver fluke is, how it’s transmitted and the harm it does. They can also use board games and digital technology, particularly immersive interactive media, to create content with which the target audience can engage. Art and digital media can make learning fun and effective, making it ideal for young people,” he said.
Danai added that the habit of ingesting undercooked and raw freshwater fish is transmitted from parents to children. It is then passed on to the next generation as the kids grow up and get married.
“Students are good agents of change. They can spread the knowledge to the family and the next generation, helping to fight the infection,” he said.
Contestant Danuphat Chuenmeesri, 17, a student from Sarakhampittayakhom School, created a short video for the contest showing how flukes take over the body and the dangers of human parasites.
“The seminar was very informative and helpful. I hope that viewers will find my work useful and understand how we can get infected with flukes and how we can protect ourselves from illness,” he said.
Another contestant, Keetanart Suwannawong, 18, a student at Mahasarakham Technical College, is using a board game to help people understand the dangers of eating raw and undercooked freshwater fish dishes.
“In this board game, you will learn about the risks of eating raw and undercooked freshwater fish dishes. As you move around the board, you will find certain Thai dishes that might pose a risk of liver fluke infection if eaten undercooked and the kinds of freshwater fish that harbour liver flukes,” he said.
Keetanart admitted that he didn’t know undercooked freshwater fish were unsafe to eat as his family rarely eats fish.
“My mother usually cooks for the family. We eat chicken, eggs and vegetables,” he said, adding that none of his family members has ever undergone screening to detect OV infection.
Alarmingly high levels of liver fluke infections among students
In July, thousands of university freshmen in Maha Sarakham were reported to have tested positive for liver fluke infections. According to media reports, at Maha Sarakham University, 4,233 of the 12,733 first-year students (about 33%) tested positive, while at Rajabhat Maha Sarakham University, 380 of 1,922 students (about 19%) tested positive.
The average infection rate among the general population in the province was about 11%, according to local health authorities.
The findings were obtained using urinary antigen test kits (UATs) with stool examinations then used to confirm the presence of infections. Developed by Khon Kaen University, the kit is specially designed to provide a faster and more convenient alternative to stool testing. It’s available through the National Healthy Security Office (NHSO) benefit scheme.
Thailand has the highest CCA rate in the world
Thailand has one of the highest rates of bile duct cancer in the world. The incidence is highest in males, especially in the Northeast and the North. The northeastern region has the highest risk, with a greater prevalence of Opisthorchis viverrini (O. viverrini).
Between 2008 and 2022, the country recorded a mortality rate of 13-35 cases per 100,000 population for bile duct cancer, with the highest rate in the Northeast.
At least 6 million people in Thailand are currently infected with the flukes. Over time, the infection can cause inflammation and will probably present after 15 or 20 years in the form of bile duct cancer, which is usually fatal.
According to data from the NHSO, in 2025, over 140,000 people were screened using OV Antigen Rapid Test Kits from 316 health care centres throughout the country. Of these, more than 40,000, or about 29.27%, tested positive, with only 23.29% receiving medication that eliminates flukes from the body.
