Neglected Tropical Diseases - Schistosomiasis

WEEKLY EPIDEMIOLOGICAL REPORT A publication of the Epidemiology Unit Ministry of Health & Indigenous Medical Services 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]

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Vol. 47 No. 36 29th– 04th Sep 2020 Neglected Tropical Diseases - Schistosomiasis

Schistosomiasis is a parasitic disease caused by blood and release larvae which mature into a form that can flukes (trematode worms). People become infected actively penetrate the skin. Infection occurs by walking when larva released by fresh water snails penetrate barefoot on the contaminated soil. the skin. Clinical features depend on site of infesta- tions: Consequences of infectio include intestinal manifesta- tions such as diarrhoea and abdominal pain, malnutri- • Intestinal schistosomiasis can result in ab- tion, general malaise and weakness, and impaired dominal pain, diarrhoea, and blood in the growth and physical development. The disease can stool. Hepatomegaly, ascites and portal hy- even lead to intestinal obstruction. Nutritional effects pertension can also occur. such as anemia, vitamin deficiencies and malab- sorbtion are also seen. • Urogenital schistosomiasis causes haematu- ria. Fibrosis of the bladder and ureter, and Treatment is with anti-helminth drugs such as albend- kidney disease can occur in advanced cases. azole and mebendazole. Prevention is by breaking the Bladder cancer may occur in later stages. chain of transmission, identifying high risk areas and Furthermore, women can develop genital lesions, mass-scale drug administration through deworming vaginal bleeding, pain during sexual intercourse, and programs. Behavioural change and environment sani- nodules in the vulva. In men, urogenital schistosomia- tation are also supplementary preventive actions. sis can affect the seminal vesicles, prostate, and other organs leading to infertility. Snake bite envenoming The disease is diagnosed via the detection of parasite eggs in stool or urine specimens. Antibodies and/or About 5.4 million snake bites occur every year. It caus- antigens detected in blood or urine samples are also es 1.8 to 2.7 million cases of envenomings. There are tested. Treatment is with praziquantel. The control of between 81 410 and 137 880 deaths each year. Three times as many amputations and other permanent disa- schistosomiasis is by large-scale treatment of at-risk bilities occur each year. population groups. Access to safe water, improved sanitation, hygiene education, and snail control are Health systems in many countries where snake bites also important factors are common often lack the infrastructure and resources to collect robust statistical data on the problem. Under-reporting of snake bite incidence and mortality is commonly seen.

SRI LANKA 2020 LANKA SRI Snake enveomation occurs mostly in women, children and farmers in poor rural communities in low- and middle-income countries. The highest incidence occurs in countries where health systems are weakest and medical resources sparse

Venomous snake bites can affect in different ways depending on the type of snake. Morbidity and mortality occurs due to neurotoxicity resulting in respiratory failure, permanent renal damage, hematotoxicity and coagulopathy and due to local envenomation with necrosis. Current available antivenom sera is used only for a limited species of snakes. The production of AVS is Figure: Lifecycle of Schistosoma spp done only in certain number of countries. Source: Center for Disease Control A Snakebite Envenoming Working Group was estab- Soil-transmitted helminth infections lished by the WHO. This strategy aims for a 50% re- duction in mortality and disability caused by snakebite The main species causing disease in humans are the envenoming by 2030. This aim will be achieved roundworm namely Ascaris lumbricoides, the whip- through four key objectives: worm such as Trichuris trichiura) and hookworms (Necator americanus and Ancylostoma duodenale). • Empower and engage communities, Adult worms live in the intestine produce thousands of • Ensure safe, effective treatment, eggs which are passed in the faeces of those infected. Eggs can contaminate food and water sources where • Strengthen health systems, and they will be ingested. Hookworm eggs hatch in the soil • Increase partnerships, coordination and re-

Contents Page

1. Leading Article – Neglected Tropical Diseases - Schistosomiasis 1 2. Summary of selected notifiable diseases reported (22nd– 28th August 2020) 3 3. Surveillance of vaccine preventable diseases & AFP (22nd– 28th August 2020) 4

WER Sri Lanka - Vol. 47 No. 36 29th– 04th Sep 2020 sources. Elimination programmes in endemic countries are being implemented using the WHO-recommended SAFE strategy. This consists of:

Teaniasis/cystercosis • Surgery to treat the blinding stage (trachomatous trichiasis); Taeniasis is an intestinal infection caused by: Taenia solium (pork • Antibiotics to treat the infection, particularly mass drug admin- tapeworm), Taenia saginata (beef tapeworm) and Taenia asiatica. istration of the antibiotic azithromycin. Humans can become infected with T. saginata or T. asiatica when they • Facial cleanliness consume infected beef meat or pig liver, respectively, which has not • Environmental improvement mainly improving access to water been cooked adequately but taeniasis due to these worms has no and sanitation. major impact on human health. Only T. solium causes major health problems. • Most endemic countries have agreed to accelerate the imple- mentation of this strategy to achieve elimination targets. Human tapeworm carriers excrete tapeworm eggs in their faeces and contaminate the environment when they defecate in open areas.

Humans can also become infected with T. solium eggs due to poor hygiene (via the fecal-oral route) or ingesting contaminated food or water. Ingested T. solium eggs develop to larvae (called cysticerci) in various organs of the human body (human cysticercosis). Human cysticercosis can result in devastating effects on human health.

Abdominal pain, nausea, diarrhoea or constipation can occur when the tapeworms grow in the intestines 2 months after ingestion of meat containing cysticerci. Infected people may develop visible or palpable nodules (beneath the skin (subcutaneous) as the larvae (cysticerci) Figure: ophthalmic lesions of repeated infection with trachoma develop in the muscles, skin, eyes and the central nervous system. When cysts develop in the brain, it is called neurocysticercosis. Symp- toms include severe headache, blindness, convulsions, and epileptic seizures, and can be fatal. Yaws (endemic trepanematoses)

T. solium is the cause of 30% of epilepsy cases in many endemic are- Yaws is a chronic disfiguring and debilitating disease which affects as. In such places people and roaming pigs live in close proximity. In skin, bone and cartilage. Humans are believed to be the only reservoir, high risk communities it can be associated with as many as 70% of and transmission is from person to person. The causative organism is epilepsy cases. More than 80% of the world's 50 million people who Treponema pallidum subspecies pertenue. Yaws initially presents as a are affected by epilepsy live in low and lower-middle income countries. papilloma which will ulcerate. Papilloma and ulcers are very infectious. Secondary yaws occurs weeks to months after the primary infection Cysticercosis mainly affects the health of subsistence farming commu- and presents with multiple raised yellow lesions or dactylitis. nities in developing countries of Africa, Asia and Latin America. In 2015, the WHO Foodborne Disease Burden Epidemiology Reference Diagnosis can be by laboratory-based serological tests such as Trepo- Group identified T. solium as a major cause of deaths from food-borne nema pallidum particle agglutination (TPPA) and rapid plasma reagin diseases, resulting in a considerable total of 2.8 million disability- (RPR). Treatment is with azithromycin or benzathine penicillin. Preven- adjusted life-years (DALYs). The total number of people affected with tions is with health education and improvement in personal hygiene to neurocysticercosis, including symptomatic and asymptomatic cases, is reduce transmission. Contacts of patients should have empiric treat- estimated to be between 2.56–8.30 million, based on the range of epilepsy prevalence data available. Although 70% of patients with ment. Mass treatment is also done. epilepsy could lead a normal life if treated correctly, poverty, ignorance of the disease, inadequate infrastructure in health or lack of access to medication, cause 75% people with this condition to be treated poorly, if treated at all.

Taenaisis can be treated with single doses of praziquantel or niclosa- mide . Albendazole at 400 g for 3 consecutive days has also been used. Neurocysterocosis may require corticosteroids. Prevention in- cludes mass drug administration, health education and sanitation in breaking transmission cycle is important. meat inspection and treatment of pigs is also needed. Figure:lesions caused by yaws

Figure: Lifecycle of Taenia solium Compiled By Source: Center for Disease Control Dr. Chathurika Herath

PG Trainee in Community Medicine, Epidemiology Unit, Ministry of Health

Trachoma References: Trachoma is caused by infection with the bacterium Chlamydia tracho- matis usually seen among the poorest of the poor, which can cause World Health Organisation: Fact sheets on NTDs permanent blindness. It is a public health problem in 44 countries and https://www.who.int/news-room/fact-sheets/detail/ is responsible for the blindness or visual impairment of about 1.9 mil- schistosomiasis lion people worldwide. Infection spreads through contact with fomites https://www.who.int/news-room/fact-sheets/detail/soil- of infected persons and by flies that have been in contact with eye/ nasal discharges of infected patients. Repeated infection can cause transmitted-helminth-infections scarring of the inner eyelid (trachomatous conjunctival scarring) which https://www.who.int/news-room/fact-sheets/detail/taeniasis- causes the eyelid to turn inwards. This causes the eyelashes to rub cysticercosis against the eyeball (trachomatous trichiasis) which can lead to corneal https://www.who.int/news-room/fact-sheets/detail/yaws scarring in the long run, the ultimate result of which will be permanent blindness. Long term it leads to scarring of the cornea and blindness.

Page 2 WER Sri Lanka - Vol. 47 No. 36 29th– 04th Sep 2020

Table 1: Selected notifiable diseases reported by Medical Officers of Health 22nd– 28th Aug 2020 (35th Week)

98 98 99 93 93 91 99 96 87 90 95

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

C**

63 54 56 42 50 64 22 31 69 17 29 65 39 64 43 52 68 45 47 57 41 60 59 50 66 49

WRCD T*

2 0 0 4 2 0 1 6 1 5 1 9 0 0

28 50 57 13 18

248 552 312 352 192 208 102

2163

8 0 0 0 0 2 0 0 8 0 0 0 0 0 0 0 0 0 5 0 0 3 0

35 12 19

Leishmani- asis A

5 8 4 5 8 0

55 38 27 37 23 12 50 43 20 10 11 28 15 30 49 51 15 32 92 36

704

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

Meningitis A

2 0

53 70 99 12 29 10 84 86 73

150 190 238 262 145 288 166 118 113 292 168 124 132 163 270

Completeness

3337

C**

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

Chickenpox A

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

Human Rabies A

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

10 12 17 13 15

133

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

Viral Viral Hepatitis A

6 2 5 2 2 0 0 9 1 0 2

40 14 89 78 51 56 10 34 11 27 15 21 83 41

506

1105

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

Fever

Typhus A

6 0

90 20 19 41 21 29 85 28 58 17

387 246 192 542 180 100 549 189 420 179 228 118 298

1228

5270

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

17 26 15 17 12 31

Leptospiro sis A

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

17 16 19 13 14 48 59 17 48 36 30 35

402

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

Food Poisoning A

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

20 11

111

Aug, 2020Aug, Total numberreportingof units356 Number reportingof units provideddata forthe current week: 310

th th

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

e e 28

Enteric Enteric Fever A

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

10 18 15 11 27

136

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

Encepha litis A

8 0 9 6 0

18 25 11 12 23 31 31 11 25 77 37 13 10 74 17 14 21 16 16 80 48

633

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

refersreturnsto received on befor or

Dysentery A

542 711 158 331 478 125 133 248 307 862 452 392 224 433 889

3763 2308 1593 2782 1532 1990 2317 2271 1772

Timeliness

26695

8 2 9 1 2 6 0 0 0 1 1 2 7 2 1 0 0 7

17 71 50 23 89 11 14 34

358

Dengue Fever A

Division

Kegalle RDHS RDHS Colombo Gampaha Kalutara Kandy Matale NuwaraEliya Galle Hambantota Matara Jaffna Kilinochchi Mannar Vavuniya Mullaitivu Batticaloa Ampara Trincomalee Kurunegala Puttalam Anuradhapur Polonnaruwa Badulla Monaragala Ratnapura Kalmune SRILANKA Source: Source: Weekly ofReturns Communicable Diseases(WRCD).

Page 3

WER Sri Lanka - Vol. 47 No. 36 29th– 04th Sep 2020 Table 2: Vaccine-Preventable Diseases & AFP 22nd– 28th Aug 2020 (35th 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 2019 2020 2020 & 2019 W C S N E NW NC U Sab 2020 2019

AFP* 00 00 00 00 01 00 00 00 00 01 01 30 54 - 44.4 %

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

Mumps 00 00 01 00 00 00 00 00 00 01 02 123 240 - 48.7%

Measles 00 00 00 00 00 00 00 00 00 00 06 37 237 - 84.3 %

Rubella 00 00 00 00 00 00 00 00 00 00 00 00 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 00 00 01 03 15 - 80 %

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

Japanese En- 00 00 00 00 00 00 00 00 00 00 00 31 10 210 % cephalitis

Whooping Cough 01 00 01 00 00 00 00 00 00 02 00 07 36 - 80.5 %

Tuberculosis 40 18 50 09 08 09 07 02 24 167 140 4191 5674 - 26.1 %

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

Number of Malaria Cases Up to End of August 2020, 02 All are Imported!!!

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

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Dr. Sudath Samaraweera CHIEF EPIDEMIOLOGIST EPIDEMIOLOGY UNIT 231, DE SARAM PLACE COLOMBO 10