WEEKLY EPIDEMIOLOGICAL REPORT A publication of the Epidemiology Unit Ministry of Health 231, de Saram Place, Colombo 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. 43 No.04 16 th – 22 nd January 2016 Filariasis in Sri Lanka (Part I) This is the first in a series of three articles on History of Filariasis in Sri Lanka filariasis in Sri Lanka. History of LF in Sri Lanka can be traced back to the 3 rd century B.C. The first all island survey Introduction was done during the period 1936 –1939 by Das- Lymphatic filariasis (LF) is one of the main sanayake. Then, the microfilaria (mf) rate was causes of permanent disability leading to socio- around 20 –24%. economic problems. Of the estimated 120 million After the establishment of Anti Filariasis Cam- people affected with LF globally in 73 countries, paign (AFC) on 24 th of October 1947, with se- 50% are in the South-East Asia Region (SEAR). lective chemotherapy and morbidity control Out of the 1.39 billion globally at risk, 63% live in through health education and recurrent vector 9 of the 11 Member States of the SEAR, requir- control measures, the mf rate was brought down ing mass drug administration (MDA) with diethyl to 5-6%. Since then, it has remained static at a carbamazine citrate (DEC) and albendazole. LF lower level of transmission. is endemic in nine countries (Sri Lanka, Mal- dives, , , , , Two types of filarial parasites have been re- , , Timor-Leste) in the SEAR. ported from Sri Lanka. i.e. Wuchereria bancrofti and . The three causative parasites of lymphatic filari- asis in the world are: Wuchereria bancrofti, Wuchereria bancrofti is the main LF infection Brugia malayi, Brugia timori . They are the most being transmitted. The main vector re- widespread and abundant of all filarial worms . sponsible for the spread of filariasis in Sri Lanka is the Culex quinquefasciatus , serves The adult parasites live in the lymphatic system, as the intermediate host, in which the microfilar- which is an essential component of the body’s ial counts coincides with the biting habits of the immune defense system. The worms have an vector. The mosquito breeds in highly polluted estimated active reproductive life span of 4-5 collection of water, such as blocked drains, dam- years producing millions of minute, immature aged septic tanks, latrine pits etc, which are larvae- microfilariae (mf) that circulate in blood. abound in urban habitats. B. malayi is transmit- The mf are transmitted from person to person by ted by annulifera , Mansonia uniformis several species of infected mosquitoes. Wucher- and Mansonia indiana and these species of eriabancrofti is mainly transmitted by C ulex spe- mosquitoes were found in association with water cies (eg: Culex quinquefasciatus ) and Brugia plants such as Pistiastratiotes, Salvinia etc. malayi / timori by Mansonia species.

Contents Page 1. Leading Article – Filariasis in Sri Lanka (Part I) 1 2. Summary of selected notifiable diseases reported (09 th – 15 th January 2016) 3 3. Surveillance of vaccine preventable diseases & AFP (09 th – 15 th January 2016) 4

WER Sri Lanka - Vol. 43 No. 04 16 th – 22 nd January 2016 Current situation of filariasis control in Sri Lanka Compiled by Dr. S.D.Samarasekara

The vertical organization, AFC of Ministry of Health, is the main Consultant Community Physician body responsible for filariasis control in Sri Lanka. In Sri Lanka {MBBS (Col), MSC ( Community Medicine), MD (Community LF is endemic in eight districts (Colombo, Kalutara, Gampaha, Medicine) } Galle, Matara, Hambantota, Kurunegala & Puttalam) in three Anti Filariasis Campaign provinces (Western, Southern & North Western Provinces) and Ministry of Health Sri Lanka about half of the population of Sri Lanka live in filariasis en- demic districts.

The AFC is staffed by the Director, Consultant Community Physician, Medical Officers, and Entomologist, Nursing sister, Public Health Inspectors, Entomological Assistants, Public Health Laboratory Technicians, office staff and labourers. The Table 1 : Water Quality Surveillance main activities of AFC are parasitological investigations and Number of microbiological water samples December/2015 control, entomological investigations and control, morbidity District MOH areas No: Expected * No: Received management and disability prevention of Lymphoedema pa- Colombo 12 72 87 tients, planning activities, health education, statistical monitor- Gampaha 15 90 92 ing at national level and provision of technical guidance to pe- Kalutara 12 72 68 ripheral filariasis units which are under the Provincial Director Kalutara NIHS 2 12 16 of Health Services (PDHS). There are Regional Anti filariasis Kandy 23 138 1 Units (RAFUs) in seven endemic districts and these are Matale 12 72 0 headed by the Regional Medical Officer – Filariasis (RMO-F). AFC and RAFUs conduct filariasis vector and parasitological Nuwara Eliya 13 78 14 surveys mainly in endemic areas and also conduct some sur- Galle 19 114 85 veys in non-endemic areas. Matara 17 102 18

Hambantota 12 72 NR Following the Global Programme to Eliminate Lymphatic Filari- asis (GPELF), the Ministry of Health initiated the national Pro- Jaffna 11 66 12 gramme to Eliminate Lymphatic Filariasis. The goal of the pro- Kilinochchi 4 24 18 gramme is achieving elimination by 2020. Elimination was de- Manner 5 30 34 fined as a mf rate of < 1% or antigen rate of < 2%. Two princi- Vavuniya 4 24 20 pal strategies of the GPELF were Mullatvu 4 24 18

Batticaloa 14 84 19 (i) interruption of transmission Ampara 7 42 NR

(ii) disability prevention and control. Trincomalee 11 66 6

AFC of Ministry of Health Sri Lanka collaborates with other Kurunegala 23 138 115 partners such as the World Health Organization (WHO), Gates Puttalam 9 54 41 Foundation, Liverpool School of Tropical Medicine-UK, Univer- Anuradhapura 19 114 0 sity of St. Louise-USA and National Institute of Health, USA. Polonnaruwa 7 42 49

Badulla 15 90 80 Objectives of AFC are to eliminate Lymphatic Filariasis by in- terruption of transmission by 2020 and to alleviate suffering Moneragala 11 66 30 and disabilities of affected individuals. Rathnapura 18 108 60 Kegalle 11 66 54

Kalmunai 13 78 NR

* No of samples expected (6 / MOH area / Month) NR = Return not received

Page 2 to be continued …. WER Sri Lanka - Vol. 43 No. 04 16 th – 22 nd January 2016 Table 2: Selected notifiable diseases reported by Medical Officers of Health 09 th – 15 th Jan 2014 (03 rd Week) 94 94 92 85 98 100 100 100 100 100 100 100 100 100 100 100 C** WRCD WRCD 92 92 100 47 47 100 61 100 53 53 100 80 80 100 40 100 57 86 83 83 100 85 85 100 81 81 71 69 80 50 25 64 83 62 71 55 74 46 46 100 96 96 100 76 94 100 100 100 100 100 100

0 0 0 4 0 0 1 0 0 0 2 0 2 2 0 16 16 20 20 10 74 74 8 0 0 0 2 0 4 0 0 0 0 0 5 0 0 27 27 Leishmani- asis 0 0

0 0 2 9 0 3 0 1 1 4 0 5 1 10 10 71 71

0 0 2 2 0 0 0 0 0 1 1 0 2 0 18 18 Meningitis

2 2 0 2 2 7 6 5 17 17 10 16 16 10 28 215 215 -Completeness C** 5 5 4 0 2 6 0 2 1 4 3 2 0 4 60 60 Chickenpox

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 rrent week:336 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Human Human Rabies 1 1 0 0 2 1 0 0 1 0 0 8 1 10 10 58 58 Viral Viral Hepatitis Hepatitis 1 1 0 0 0 0 0 0 0 1 0 0 1 1 15 15 0 0 3 2 8 6 1 0 1 0 6 2 13 13 15 287 287 Fever Fever Typhus 0 0 0 0 3 2 1 0 0 0 2 0 2 0 68 68 Number ofreporting units data provided for cu the 4 4 3 3 3 0 7 31 31 14 33 13 25 42 30 373 373 1 1 7 4 3 0 0 0 0 0 4 10 10 11 12 87 87 Leptospirosis Leptospirosis 0 0 0 0 2 0 1 0 0 0 0 0 3 26 26 47 47 Food Food Poisoning Poisoning 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 6 6 1 1 0 0 2 0 2 1 0 0 1 10 10 46 46 1 1 0 0 0 0 1 0 1 1 0 0 0 0 Januaryl 2016 , Total numberofreporting units339 11 11 th Enteric Fever Enteric 15

0 0 0 0 1 1 0 0 0 0 0 0 1 3 19 19 s 0 0 0 0 0 1 0 0 0 0 0 0 0 1 5 5 Encephaliti (WRCD). 6 6 2 6 4 5 1 6 3 5 3 2 12 12 23 170 170 =Cumulative cases for year. the 5 5 2 1 1 0 0 0 9 3 0 3 0 0 Dysentery 54 54 B 6 6 20 20 76 36 68 56 71 31 40 137 137 130 119 1014 1014 3118 3118 Timelinessrefers toreturns received on before or T= * 8 8 0 6 2 23 2 1 12 1 2 0 0 6 3 0 0 0 0 0 1 1 8 0 0 0 43 0 0 0 4 0 0 2 9 0 0 5 0 0 0 0 1 0 2 11 0 0 0 0 0 3 0 1 1 0 0 0 2 0 0 0 12 0 0 1 55 0 0 0 1 0 0 0 3 0 0 0 0 0 1 0 1 0 2 0 0 0 0 0 1 4 0 0 7 0 0 1 2 10 61 61 230 55 0 50 1 161 18 5 0 17 3 28 9 15 0 2 0 22 42 2 3 1 1 0 3 0 0 7 3 0 0 3 0 0 0 4 3 2 0 0 10 20 0 0 28 0 1 2 0 19 1 1 6 0 36 7 3 1 106 21 2 0 0 4 8 15 0 3 13 13 0 5 4 0 0 0 18 11 20 0 2 1 1 11 59 0 0 6 0 3 26 1 2 0 1 0 27 0 0 1 95 8 0 3 12 0 0 0 4 4 4 0 62 5 0 8 0 17 0 1 2 0 1 1 3 6 15 0 1 1 0 2 0 0 0 9 0 3 4 0 0 1 0 3 2 1 0 10 0 0 3 3 0 0 10 19 4 3 0 0 16 4 1 1 1 0 0 3 4 0 13 5 0 5 0 0 8 0 0 1 4 0 13 6 0 0 3 0 7 2 0 0 0 2 0 0 328 328 135 447 7 26 1 1 1 6 1 5 1 3 45 180 0 0 0 0 1 6 0 2 Dengue Fever Fever Dengue 932 932 RDHS RDHS Division Division SRILANKA = Casesreported duringthe current week. Colombo Gampaha Kalutara A Kandy Matale B NuwaraEliya A Galle B Hambantota A 0Matara B Jaffna A Kilinochchi B Mannar A Vavuniya B Mullaitivu Batticaloa A B Trincomalee A Kurunegala B Puttalam A B Polonnaruwa A Badulla B A Monaragala Ratnapura B Kegalle A Kalmune B A B T* Ampara Ampara Anuradhapura Source: Weekly Returnsof Communicable Diseases A Page 3

WER Sri Lanka - Vol. 43 No. 04 16 th – 22 nd January 2016 Table 3: Vaccine-Preventable Diseases & AFP 09 th – 15 th Jan 2014 (03 rd Week) Number of Number of Total Total num- Difference cases cases No. of Cases by Province number of ber of between the during during cases to cases to number of Disease current same date in date in cases to date week in week in 2016 2015 in 2016 & 2015 W C S N E NW NC U Sab 2016 2015

AFP* 00 01 00 00 00 00 00 00 00 01 02 03 06 -50%

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

03 Mumps 01 00 00 01 00 00 00 01 00 06 17 15 +13.3%

Measles 02 01 00 00 03 03 00 00 00 09 28 37 68 +46.1%

Rubella 01 00 00 00 00 00 00 00 00 01 00 01 02 -50%

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 00 00 00 0%

Neonatal Teta- 00 00 00 00 00 00 00 00 00 00 00 00 00 0% nus

Japanese En- 00 00 00 00 00 00 00 00 00 00 01 00 02 -100% cephalitis

Whooping 01 00 01 00 00 00 02 00 00 04 01 05 05 0% Cough

Tuberculosis 30 11 15 10 09 07 00 06 23 111 101 504 366 +38.1%

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 ), CRS** = Congenital Rubella Syndrome AFP and all clinically confirmed Vaccine Preventable Diseases except Tuberculosis and Mumps should be investigated by the MOH

Influenza Surveillance in Sentinel Hospitals - ILI & SARI Human Month No Received ILI SARI Infl A Infl B Pooled samples Serum Samples Positives

December 2041 56 11 24 01 1546 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 publishing data in this publication ON STATE SERVICE

Dr. P. PALIHAWADANA CHIEF EPIDEMIOLOGIST EPIDEMIOLOGY UNIT 231, DE SARAM PLACE COLOMBO 10