WEEKLY EPIDEMIOLOGICAL REPORT A publication of the Epidemiology Unit Ministry of Health, Nutrition & Indigenous Medicine 231, de Saram Place, Colombo 01000, Sri Lanka 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. 46 No. 04 19th – 25th January 2019 Trypanosomiasis, human African (sleeping sickness)

Human African trypanosomiasis, also known as sleep- Another form of trypanosomiasis occurs mainly in Latin ing sickness, is a vector-borne parasitic disease. It is America. It is known as American trypanosomiasis or caused by infection with protozoan parasites belonging Chagas disease. to the genus Trypanosoma. Human African trypanosomiasis , transmitted by the Disease burden bite of the 'Glossina' insect, commonly known as the Sleeping sickness threatens millions of people in 36 tsetse fly. countries in sub-Saharan Africa. Many of the affected They are transmitted to humans by tsetse fly populations live in remote rural areas with limited ac- (Glossina genus) bites which have acquired their infec- cess to adequate health services, which complicates tion from human beings or from animals harbouring the surveillance and therefore the diagnosis and treat- human pathogenic parasites. ment of cases. In addition, displacement of popula- Tsetse flies are found just in sub-Saharan Africa tions, war and poverty are important factors that facili- though only certain species transmit the disease. Rural tate transmission. populations living in regions where transmission oc- curs and which depend on agriculture, fishing, animal During the most recent epidemic the prevalence husbandry or hunting are the most exposed to the reached 50% in several villages in Angola, the Demo- tsetse fly and therefore to the disease. cratic Republic of the Congo, and South Sudan. Sleep- Human African trypanosomiasis takes 2 forms, de- ing sickness was the first or second greatest cause of pending on the parasite involved: mortality in those communities, even ahead of HIV/ AIDS.

 Trypanosoma brucei gambiense is found in 24 Infection and symptoms

countries in west and central Africa. This form SRI LANKA 2019 LANKA SRI currently accounts for 97% of reported cases of The disease is mostly transmitted through the bite of sleeping sickness and causes a chronic infection. an infected tsetse fly but there are other ways in which A person can be infected for months or even people are infected: years without major signs or symptoms of the disease. When more evident symptoms arise, the patient is often already in an advanced disease Mother-to-child infection: the trypanosome can cross stage where the central nervous system is affect- the placenta and infect the foetus. ed. Mechanical transmission through other  Trypanosoma brucei rhodesiense is found in 13 countries in eastern and southern Africa. Nowa- days, this form represents under 3% of reported  blood-sucking insects is possible, however, it is cases and causes an acute infection. First signs difficult to assess its epidemiological impact. and symptoms are observed a few months or  Accidental infections have occurred in laborato- weeks after infection. The disease develops rap- ries due to pricks with contaminated needles. idly and invades the central nervous system. Only Uganda presents both forms of the disease, but  Transmission of the parasite through sexual con- in separate zones. tact has been documented. Contents Page 1. Leading Article – Diabetes 1 2. Summary of selected notifiable diseases reported (12nd – 18th January 2019) 3 3. Surveillance of vaccine preventable diseases & AFP (12nd – 18th January 2019) 4

WER Sri Lanka - Vol. 46 No. 04 19th– 25th January 2019 In the first stage, the trypanosomes multiply in subcutaneous tissues, where there are tsetse flies that transmit the disease. The people blood and lymph. This is also called haemo-lymphatic stage, which most exposed to the tsetse fly live in rural areas . entails bouts of fever, headaches, joint pains and itching. Early diagnosis and treatment can completely cure the disease. In the second stage the parasites cross the blood-brain barrier to infect Sleeping sickness is curable with medication, but is fatal if left the central nervous system. This is known as the neurological or me- untreated. ningo-encephalic stage. In general this is when more obvious signs and symptoms of the disease appear: changes of behaviour, confu- Source: Trypanosomiasis, human African (sleeping sickness) Fact sion, sensory disturbances and poor coordination. Disturbance of the Sheet .Available at :https://www.who.int/news-room/fact-sheets/ sleep cycle, which gives the disease its name, is an important feature. detail/trypanosomiasis-human-african-(sleeping-sickness) Without treatment, sleeping sickness is considered fatal although cas- es of healthy carriers have been reported. CDC. African Trypanosomiasis, https://www.cdc.gov/parasites/ sleepingsickness/index.html Disease management: diagnosis Compiled by : Disease management is made in 3 steps:

 Screening for potential infection. This involves using serological Dr. Shilanthi Seneviratne , Epidemiology unit / Ministry of Health tests (only available for T.b.gambiense) and checking for clinical signs Sri Lanka - especially swollen cervical lymph nodes.

 Diagnosing by establishing whether the parasite is present in Table 1 : Water Quality Surveillance Number of microbiological water samples December body fluids. 2018 Staging to determine the state of disease progression. This entails District MOH No: Expected No: Received examining the cerebrospinal fluid obtained by lumbar puncture. Diag- areas * nosis must be made as early as possible to avoid progressing to the Colombo 15 90 102 neurological stage. Exhaustive screening requires a major investment Gampaha 15 90 NR in human and material resources. In Africa such resources are often Kalutara 12 72 NR scarce, particularly in remote areas where the disease is mostly found. As a result, some infected individuals may die before they can ever be Kalutara NIHS 2 12 NR diagnosed and treated. Kandy 23 138 NR Treatment Matale 13 78 74 The type of treatment depends on the disease stage. The drugs used Nuwara Eliya 13 78 NR in the first stage are safer and easier to administer than those for the Galle 20 120 NR second stage. Also, the earlier the disease is identified, the better the Matara 17 102 NR prospects of a cure. The assessment of treatment outcome requires Hambantota 12 72 37 follow up of the patient up to 24 months and entails laboratory exams Jaffna 12 72 of body fluids including cerebrospinal fluid obtained by lumbar punc- 136 ture, as parasites may remain viable for long periods and reproduce Kilinochchi 4 24 1 the disease months after treatment. Manner 5 30 NR Treatment success in the second stage depends on drugs that cross Vavuniya 4 24 NR the blood-brain barrier to reach the parasite. Such drugs are toxic and Mullatvu 5 30 NR complicated to administer. In total five different drugs are used for the Batticaloa 14 84 109 treatment of sleeping sickness. These drugs are donated to WHO by Ampara 7 42 35 manufacturers and distributed free of charge to disease endemic coun- Trincomalee 11 66 NR tries. There is no vaccine or drug for prophylaxis against African trypanoso- Kurunegala 29 174 111 miasis. Preventive measures are aimed at minimizing contact with Puttalam 13 78 NR tsetse flies. Anuradhapura 19 114 16 Although the parasite causing human African trypanosomiasis was Polonnaruwa 7 42 40 identified only in 1901, 'sleeping sickness' is thought to have exist- Badulla 16 96 66 ed on the African continent for centuries. WHO's ultimate objective Moneragala 11 66 75 is the elimination of human African trypanosomiasis as a public Rathnapura 18 108 NR health problem and the implementation of sustained surveillance in Kegalle 11 66 62 all disease-endemic countries. Kalmunai 13 78 NR

Sleeping sickness occurs in 36 sub-Saharan African countries * No of samples expected (6 / MOH area / Month) NR = Return not received Page 2 WER Sri Lanka - Vol. 46 No. 04 19th– 25th January 2019

Table 1: Selected notifiable diseases reported by Medical Officers of Health 12th – 18th Jan 2019 (3rd Week)

98 97 93 67 78 97 98

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

C**

67 44 52 59 61 23 62 69 63 26 42 53 25 50 67 43 39 52 59 39 50 56 67 40 55 51 53

WRCD T*

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

32 11 60 39 56 37 19

266

B

0 3 3 1 0 0 0 0 0 0 0 0 0 0 0 5 7 0 0 0 0 0

17 35 14 16

10

Leishmania- sis A

1 8 1 4 1 5 0 2 2 0 0 0 1 0 1 0 7 0 1 4 8 1 0

10 14 12

83

B

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

26

Meningitis A

7 4 0 0 8 0 8 4 9 9

30 27 69 19 26 17 23 13 14 39 31 22 16 22 30 32

479

Completeness

-

B

C**

2 8 5 1 6 6 5 0 0 0 0 1 8 0 9 3 9 6 7 9 7 4

11 21 10 13

151

Chickenpox A

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

2

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

Human Human Rabies A

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

19

B

1 1 0 0 0 0 0 0 1 0 1 0 0 0 0 2 0 0 0 1 0 0 0 0 0 0

7

Viral Viral Hepatitis A

0 3 0 1 8 4 8 4 2 2 2 0 0 0 3 2 1 1 8 7 1 2 0

15 10 82

166

B

0 1 0 0 2 1 2 7 4 2 2 0 1 0 0 0 2 1 0 1 3 1 0 0 0

28

Fever

58

Typhus A

9 8 3 5 5 7 7 9 0 3 2 5 5 0 4 0

46 12 20 22 23 10 24 27 38 11

305

B

3 4 1 4 3 6 1 1 5 5 0 0 1 0 1 0 8 1 4 3 4 5 9 4 0

12

85

Leptospirosis A

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

10 13

38

B

0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 1 0

5

Food Food Poisoning A

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

15

B

0 0 0 0 0 0 0 0 0 1 1 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0

6

January , Total2019 number reporting of units353 Number reporting of unitsdata providedforthe current week: 344

th th

Enteric Fever Enteric A

. .

0 1 1 3 0 0 1 0 2 1 0 0 1 0 0 0 0 4 0 2 1 1 0 7 1 0

26

B

0 0 1 1 0 0 1 0 2 0 0 0 0 0 0 0 0 1 0 0 0 1 0 2 0 0

9

Encephaliti s A

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

10 15

93

B

1 3 0 0 0 0 0 1 1 2 2 0 0 1 5 1 0 1 0 0 3 1 0 3 2 4

= Cumulative= cases for year the

31

B B

Dysentery A

.

refersreturnsto received on before or 18

45 22 19 24 34 11 21 77 63 39 31 67 48 90

884 539 281 219 100 111 155 710 148 171 129 109

4147

B

Timeliness

T=

*

3 8 5 5 6 5

19 78 70 43 37 42 10 41 58 20 19 12 23 13 36 36 36

259 161 211

1256

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. 46 No. 04 19th– 25th January 2019 Table 2: Vaccine-Preventable Diseases & AFP 12th – 18th Jan 2019 (3rd 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 2018 2019 2019 & 2018 W C S N E NW NC U Sab 2019 2018

AFP* 01 02 00 00 00 00 00 00 00 03 02 06 03 100 %

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

Mumps 00 00 02 00 01 01 01 00 01 06 03 18 10 80 %

Measles 01 00 01 00 00 00 01 00 00 03 03 10 06 66.6 %

Rubella 00 00 00 00 00 00 00 00 00 00 00 00 02 -100 %

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

Tetanus 00 00 00 00 00 00 00 00 00 00 01 02 04 - 50 %

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 01 02 04 50 % cephalitis

Whooping Cough 02 00 01 00 00 01 00 00 00 04 01 05 02 150 %

Tuberculosis 78 15 39 11 10 03 00 09 33 198 175 509 462 10.1%

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 95 14 10 4 2247 2001 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