WEEKLY EPIDEMIOLOGICAL REPORT A publication of the Epidemiology Unit Ministry of Health, Nutrition & Indigenous Medicine 231, de Saram Place, 01000, Tele: + 94 11 2695112, Fax: +94 11 2696583, E mail: [email protected] Epidemiologist: +94 11 2681548, E mail: [email protected] Web: http://www.epid.gov.lk

Vol. 45 No. 04 20th – 26th January 2018 Dengue Epidemic 2017: Evidence and Lessons Learnt — Part 2 This article, discussed here as the second Western Province showed an 8-fold in- of 5 parts, summarizes the events behind crease in the incidence of Dengue cases the epidemic in 2017. while district had a 5-fold rise. Interestingly, Moneragala district in the (Continued from Previous WER) Uva Province had an incidence ten-times All districts had generally reported an in- that of the last 5 years reference value creased number of cases in 2017 while district showed only a 5-fold (compared with the 5-year reference val- rise during the year 2017. and ues). In the Western Province, Colombo districts in the Sabaragamuwa showed an increase of 3-fold while Kalu- Province showed a 6 & 5-fold increase, tara and districts had a 5-fold respectively. In the North-Central Province, rise in Dengue incidence. In the Central district showed a 5-fold in- Province, and districts rec- crease in the Dengue incidence while Pol- orded a 6-fold and 5-fold rise respectively onnaruwa had a 3-fold rise. while Nuwara-Eliya showed only a 3-fold These districts illustrate a distinct spatial increase in case incidence compared to dispersion of the dengue cases from all the last 5 years. In the Southern Province, over the island, and it is notable, that rela- Matara district showed a very high inci- tively more Dengue patients were report- dence with an 11-fold increase while ed, in 2017, from districts in the dry zone, and had only a 4-fold rise in compared to previous years. Dengue cases. district in the Eastern Province also showed an 11-fold As expected with the monsoonal rains, an increase in Dengue incidence compared to increase in the dengue cases was seen the last 5 years. had a 6-fold during the final few weeks of 2016. There rise, while and RDHS was an average of 1,000 to 1,500 cases areas each showed a 5-fold increase. In per week, mainly from the southern, north- the Northern Province, district ern and eastern parts of the country during showed only a 4-fold rise while the last months of 2016. This trend contin- and Killinochchi showed a 6-fold increase ued during the initial periods of 2017, re- and Mannar and Mullaitivu had only a 3- sulting in high caseloads being reported fold rise during the year compared to last 5 compared to last 5 years. years. district in the North- Contents Page 1. Leading Article – Dengue Epidemic 2017 : Evidence and Lessons Learnt — Part 2 1 2. Summary of selected notifiable diseases reported (13th – 19th January 2018) 3 3. Surveillance of vaccine preventable diseases & AFP (13th – 19th January 2018) 4

WER Sri Lanka - Vol. 45 No. 04 20th– 26th January 2018 In January, a general increase in cases with an unusual- tricts. ly high number of cases being reported from RDHS are- May and June were critical months in the 2017 outbreak, as of Galle, Hambantota, Matara, Killinochchi, Mannar, with Health Department resources being stretched be- Kalmunai, and Trincomalee was seen (which are mostly yond their capabilities, as dengue was being reported dry-zone districts). Galle and Kalmunai had already ex- from all parts of the island in very large numbers. There perienced an outbreak during the latter part of 2016 was an almost 3½ times increase in the caseload during while the MOH division in the Trincomalee dis- the month of May compared to the same mid-year val- trict had reported Dengue outbreaks, starting from early ues of the last 5 years. It should be noted that some dis- 2017. Characteristically, these are densely populated tricts like Hambantota, Matara, Batticaloa, Kurunegala, areas with scarcity of drinking water due to the drought Puttalam, and Moneragala had more than a 5-fold in- conditions. People tend to store water inside their hous- crease in the cases during this month. es, in ground-level, open cement tanks and other water containers, which resulted in abundant mosquito breed- (to be continued…) ing sites in these areas. Wells in these water-scarce dry Compiled by Dr. M. B. Azhar Ghouse, zones, were not adequately covered and were without Registrar in Community Medicine, Epidemiology Unit any larvivorous fish, possibly contributing to the in- Table 1 : Water Quality Surveillance creased population of Aedes mosquitoes. Number of microbiological water samples December 2017 District MOH areas No: Expected * No: Received February 2017, saw an almost doubling of the caseload Colombo 15 90 47 (compared to the 5-year mean+2SD value), with Trinco- Gampaha 15 90 NR malee district reporting more than a twelve-fold increase 12 72 NR in cases, mainly from the Kinniya area. Kilinochchi Kalutara NIHS 2 12 NR showed a nine-fold increase while Galle, Mannar, and Kandy 23 138 NR Vavuniya also showed a sharp increase during this Matale 13 78 NR month. Galle reported a 6-fold rise in cases mainly due 13 78 61 to an outbreak in Balapitiya and Ambalangoda areas. Galle 20 120 NR Matara 17 102 88 Dengue cases recorded during March 2017 were nearly Hambantota 12 72 NR 4-times greater compared to the last 5-year average val- Jaffna 12 72 82 ue. The outbreak in Kinniya in Trincomalee district saw a Kilinochchi 4 24 31 sharp increase in the caseload with 15 deaths being re- Manner 5 30 NR ported within a span of 3 weeks. The inadequacy of hu- Vavuniya 4 24 NR man and physical resources at local hospitals, to handle Mullatvu 5 30 NR Batticaloa 14 84 95 the large influx of patients, was a main reason for the Ampara 7 42 26 high mortality from these areas. Other dry-zone districts Trincomalee 11 66 38 like Hambantota, Jaffna, Kilinochchi, Mannar, Vavuniya, Kurunegala 29 174 59 Batticaloa, and Moneragala, also reported a high inci- Puttalam 13 78 98 dence of Dengue during this month. Anuradhapura 19 114 68 7 42 24 In April, there was a 4-fold increase compared to the 5- Badulla 16 96 118 year base-line (Mean+2SD) in the caseload from all cor- Moneragala 11 66 101 ners of the island. This was the beginning of the out- Rathnapura 18 108 81 break with a total of 61 deaths being recorded. More Kegalle 11 66 22 than a five-fold rise was seen in Gampaha, Hambantota, Kalmunai 13 78 37 Mannar, Kilinochchi, Batticaloa and Trincomalee dis- * No of samples expected (6 / MOH area / Month) NR = Return not received

Page 2 to be continued… WER Sri Lanka - Vol. 45 No. 04 20th– 26th January 2018

Table 1: Selected notifiable diseases reported by Medical Officers of Health 13th – 19th Jan 2018 (03rd Week)

95 42 98 93 73 97 95 96 95

100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100

C**

69 52 78 63 64 18 44 58 62 33 33 33 67 55 69 48 38 65 72 49 71 52 45 39 70 44 55

WRCD T*

1 1 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 3 0 0

75 22 10 11 16 46

188

B

0 0 0 0 0 0 0 3 3 0 0 0 0 0 0 0 0 4 0 5 0 1 1 0 0

12

29

Leishmania- sis A

1 6 1 6 1 1 0 1 0 0 0 1 1 0 2 0 0 8 3 0 2 7 0 1 1

12

55

B

1 2 1 2 0 0 0 0 0 0 0 1 0 0 1 0 0 6 1 0 0 2 0 5 1 0

23

Meningitis A

3 4 0 7 1 0 2 9 6 8

33 34 29 15 20 15 14 14 16 26 16 10 21 11 18 18

350

Completeness

-

B

C**

2 9 3 1 7 4 5 0 1 1 0 1 5 6 7 1 6 4 4 3 6 5

17 14 11 10

133

Chickenpox A

0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0

2

B

0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0

1

Human Human Rabies A

1 0 2 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 1 2 1 1 3 0

14

B

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0

Viral Viral Hepatitis A

0 0 0 0 8 5 3 3 0 2 0 2 1 0 0 3 3 1 5 0 3 7 2 2 0

76

126

B

0 0 0 0 1 4 0 1 0 1 0 1 0 0 0 0 0 1 2 0 0 4 1 1 0

24

Fever

41

Typhus A

1 6 2 6 1 0 1 3 2 1 5 5 9 9 1

14 10 19 16 17 11 14 18 24 40 27

262

B

0 4 5 2 2 1 0 0 2 1 0 1 2 1 1 7 1 1 4 9 1 7 3 1

10 12

78

Leptospirosis A

0 1 5 0 0 1 0 0 5 0 0 5 0 0 0 0 1 1 0 5 0 1 0 2

12 13

52

B

0 0 3 0 0 1 0 0 2 0 0 0 5 0 0 0 0 0 1 0 5 0 0 0 0

13

30

Food Food Poisoning A

0 4 3 0 0 1 0 0 1 6 3 1 4 0 0 0 1 2 0 1 0 2 1 4 0 0

34

B

0 3 3 0 0 0 0 0 0 1 1 0 1 0 0 0 0 2 0 1 0 0 0 1 0 0

January , Total2018 number reporting of units349 Number reporting of unitsdata providedforthe current week: 325

13

th th

Enteric Fever Enteric A

. .

0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 1 0 0 5 0 0

10

B

0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0

3

Encephaliti s A

1 2 6 5 2 0 1 1 2 3 5 0 0 3 5 3 7 2 9 4 2

12 17 10 12 18

132

B

0 0 2 2 0 0 1 0 0 6 0 0 0 0 8 1 1 5 1 2 2 1 3 2 1 1

= Cumulative= cases for year the

39

B B

Dysentery A

.

refersreturnsto received on before or 19

9

18 42 97 25 11 63 14 72 81 34 64

106 881 564 331 368 100 517 453 414 394 151 147 145 459

5560

B

Timeliness

T=

*

3 6 4 1 8

24 87 97 10 36 36 17 12 24 13 18 53 51 66

291 162 131 142 143 119 150

1704

Dengue Fever Fever Dengue A

= reportedCases duringthe current week

Division

Kegalle RDHS RDHS Colombo Gampaha Kalutara Kandy Matale NuwaraEliya Galle Hambantota Matara Jaffna Kilinochchi Mannar Vavuniya Mullaitivu Batticaloa Ampara Trincomalee Kurunegala Puttalam Anuradhapura Polonnaruwa Badulla Monaragala Ratnapura Kalmune SRILANKA

Source: Source: Weekly ofReturns Communicable Diseases(WRCD). A Page 3

WER Sri Lanka - Vol. 45 No. 04 20th– 26th January 2018 Table 2: Vaccine-Preventable Diseases & AFP 13th – 19th Jan 2018 (03rd Week) Number of Number of Total num- Difference cases cases Total num- No. of Cases by Province ber of between the during during ber of cases cases to number of Disease current same to date in date in cases to date in week in week in 2017 2018 2018 & 2017 W C S N E NW NC U Sab 2018 2017

AFP* 00 01 00 00 00 00 00 01 00 02 01 03 05 - 40 %

Diphtheria 00 00 00 00 00 00 00 00 00 00 00 00 00 0 %

Mumps 00 00 02 01 00 00 00 00 00 03 03 10 16 -37.5 %

Measles 01 01 00 00 00 01 00 00 00 03 11 06 26 -76.9%

Rubella 00 00 00 00 00 00 00 00 00 00 00 02 00 0 %

CRS** 00 00 00 00 00 00 00 00 00 00 00 00 00 0 %

Tetanus 00 00 00 00 00 00 00 00 01 01 00 04 00 0 %

Neonatal Tetanus 00 00 00 00 00 00 00 00 00 00 00 00 00 0 %

Japanese En- 00 00 00 01 00 00 00 00 00 01 00 04 04 0 % cephalitis

Whooping Cough 00 00 00 00 00 00 00 00 01 01 00 02 01 100 %

Tuberculosis 108 19 14 05 12 11 02 02 02 175 171 462 460 - 0.4%

Key to Table 1 & 2 Provinces: W: Western, C: Central, S: Southern, N: North, E: East, NC: North Central, NW: North Western, U: Uva, Sab: Sabaragamuwa. RDHS Divisions: CB: Colombo, GM: Gampaha, KL: Kalutara, KD: Kandy, ML: Matale, NE: Nuwara Eliya, GL: Galle, HB: Hambantota, MT: Matara, JF: Jaffna, KN: Killinochchi, MN: Mannar, VA: Vavuniya, MU: Mullaitivu, BT: Batticaloa, AM: Ampara, TR: Trincomalee, KM: Kalmunai, KR: Kurunegala, PU: Puttalam, AP: Anuradhapura, PO: Polonnaruwa, BD: Badulla, MO: Moneragala, RP: Ratnapura, KG: Kegalle. Data Sources: Weekly Return of Communicable Diseases: Diphtheria, Measles, Tetanus, Neonatal Tetanus, Whooping Cough, Chickenpox, Meningitis, Mumps., Rubella, CRS, Special Surveillance: AFP* (Acute Flaccid Paralysis ), Japanese Encephalitis CRS** =Congenital Rubella Syndrome NA = Not Available

Influenza Surveillance in Sentinel Hospitals - ILI & SARI

Human Animal Month No Total No Positive Infl A Infl B Pooled samples Serum Samples Positives

January 360 76 20 56 789 421 0

Source: Medical Research Institute & Veterinary Research Institute

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Comments and contributions for publication in the WER Sri Lanka are welcome. However, the editor reserves the right to accept or reject items for publication. All correspondence should be mailed to The Editor, WER Sri Lanka, Epidemiological Unit, P.O. Box 1567, Colombo or sent by E-mail to [email protected]. Prior approval should be obtained from the Epidemiology Unit before pub- lishing data in this publication

ON STATE SERVICE

Dr. S.A.R. Dissanayake CHIEF EPIDEMIOLOGIST EPIDEMIOLOGY UNIT 231, DE SARAM PLACE COLOMBO 10