Neglected Tropical Diseases - Buruli Ulcer

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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. 32 01st– 07th Aug 2020 Neglected Tropical Diseases - Buruli Ulcer

Buruli Ulcer is a chronic debilitating disease caused by an environmental mycobacterium known as Mycobacterium ulcerans. which pro- duces a toxin known as mycolactone. It is a disease affecting the skin, but infection can spread to bones as well, causing permanent disfigure- ment and disability. The mode of infection in humans is at present unknown. Buruli ulcer has been reported in 33 countries in Africa, the Americas, Asia and the Western Pacific. As there is yet no standard mode of prevention of the disease, early diagnosis and treatment with Chagas Disease/ American trypanosomiasis antibiotics are vital to minimizing disease mor- bidity. Chagas Disease, which more commonly seen in Buruli Ulcers occur in the limbs 90% of the time the Latin Americas is a potentially life- and may present in one of the following forms threatening illness that has affected 6-7 million early-on in the disease: world over. It is caused by a protozoan known as • a painless swelling/nodule Trypanosoma cruzi which is transmitted to humans through contact with faeces and/or urine of • a large painless area of induration infected triatomine bugs. These nocturnal bugs SRI LANKA 2020 LANKA SRI • diffuse oedema of the limbs and/or face. dwell in cracks of poorly constructed buildings Without appropriate care and management, and are active during the night. These bugs suck these lesions can ulcerate within 4 weeks. Nod- on human blood and defaecate on human skin. ules are often misdiagnosed as boils, lipomas, The protozoan is transmitted to humans when ganglions etc; indurations as insect bites and the bugs’ faeces comes in contact with a break oedema as cellulitis. Therefore, careful examina- in skin, or by consumption of food that has been tion and differentiation of these lesions is of im- contaminated with the bugs’ waste, which can portance for early detection. even result in outbreaks. Other methods of blood Medical treatment of Buruli Ulcer consists of a -borne transmission such as mother-to-child combination of rifampicin and clarithromycin. transmission, organ transplantation and blood or Surgical care includes proper wound care, man- blood product transfusion have also been seen agement of lymphoedema and surgery

(debridement and skin grafting) where neces-

sary.

Source: Wikipedia

Contents Page 1. Leading Article – Neglected Tropical Diseases - Buruli Ulcer 1 2. Summary of selected notifiable diseases reported (25th– 31st July 2020) 3 3. Surveillance of vaccine preventable diseases & AFP (25th– 31st July 2020) 4

WER Sri Lanka - Vol. 47 No. 32 01st– 07th Aug 2020 The disease can be described in two phases Initial Acute Phase Chronic Phase

lasts for about 2 months after infection the parasites are hidden mainly in the muscles of the A high number of parasites circulate in the blood heart and digestive system. symptoms are absent or mild and unspecific in majori-

ty of patients up to 30% of patients suffer from cardiac disorders

In less than 50%, characteristic first visible signs can up to 10% suffer from digestive (typically enlargement be a skin lesion or a purplish swelling of the lids of the oesophagus or colon), neurological or of one eye. mixed alterations.

Additionally, fever, headache, enlarged lymph glands, In later years the infection can lead to sudden death pallor, muscle pain, difficulty in breathing, swell- due to cardiac arrhythmias or progressive heart ing, and abdominal or chest pain may be seen. failure caused by the destruction of the heart muscle and its nervous system.

Treatment with benznidazole or nifurtimox is 100% effective at curing the disease if given in the acute stage of infection. Vec- Chikungunya tor control, by way of insectides has been the most effective method of prevention and control while screening of blood Chikungunya is a disease characterized by acute fever and products is also a vital component of disease prevention. severe arthralgia which may often be confused with dengue. It is caused by a RNA virus, and similar to dengue, is transmitted Dengue to humans by the female Aedes mosquito. Chikungunya has resulted in severe outbreaks in the American, African and Dengue is a mosquito-borne viral disease transmitted to hu- Asian subcontinents. Most patients make a full recovery, but mans by the female Aedes mosquito when it sucks on human arthralgia may persist in some patients for several months. blood. These mosquitoes which are daytime biters, are also Serious complications are not frequently observed. However, vectors of chikungunya, yellow fever and Zika viruses. Dengue the disease may contribute to death in the elderly. infection has spread rapidly within the tropics as a result of climate change and unplanned urbanization, with outbreaks Compiled By : coinciding with rainfall, warmer seasons and relative humidity. Dr. Chathurika Herath In fact, some countries, including Sri Lanka are hyperendemic PG Trainee in Community Medicine, to the disease. The Dengue virus is a flavivirus which has 4 Epidemiology Unit, Ministry of Health serotypes (DENV-1, DENV-2, DENV-3 and DENV-4) and infection with one serotype is believed to produce lifelong immunity towards that particular serotype. Dengue can result in a range of disease, ranging from subclini- References: cal infection to severe disease, with deleterious outcomes. The World Health Organisation: Fact sheets on NTDs commonest symptom of presentation is an acute fever, which https://www.who.int/news-room/fact-sheets/detail/buruli-ulcer- when accompanied with any 2 of severe headache, arthralgia, (mycobacterium-ulcerans-infection) myalgia, retro-orbital pain, nausea, vomiting or rash, should https://www.who.int/health-topics/chagas-disease#tab=tab_1; alert a clinician. Patients can progress from mild disease and https://www.who.int/news-room/fact-sheets/detail/chagas- enter the critical phase, when they will have to be carefully disease-(american-trypanosomiasis) managed to prevent complications. https://www.who.int/news-room/fact-sheets/detail/dengue-and- Environmental sanitation and vector control form the mainstay severe-dengue modes of prevention and control of Dengue https://www.who.int/news-room/fact-sheets/detail/ chikungunya#:~:text=Chikungunya%20is%20a%20viral% 20disease,%2C%20nausea%2C%20fatigue%20and%20rash.

Page 2 WER Sri Lanka - Vol. 47 No. 32 01st– 07th Aug 2020

Table 1: Selected notifiable diseases reported by Medical Officers of Health 25th– 31st July 2020 (31st Week)

98 99 99 93 94 92 99 96 90 96 99 95

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

C**

63 56 42 99 63 23 31 68 16 32 39 65 42 52 67 46 46 57 41 61 59 50 55 71 49

WRCD T*

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

40 53 13 17 91 22

214 477 277 303 158 178

1867

2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 8 1 0

29 13 11 10 13

Leishmani- asis A

2 9 6 4 4 8 0

33 20 33 21 10 35 37 16 10 18 15 25 40 41 13 30 84 41 34

589

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

Meningitis A

2 9 0

47 69 93 12 29 78 99 81 70

184 227 251 141 272 155 113 282 163 117 126 154 140 267

Completeness

3181

C**

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

Chickenpox A

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

Human Rabies A

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

12 17 13 13

122

1 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

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

13 82 67 42 43 27 24 14 20 65 35 37

492

1000

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

Fever

Typhus A

6 0

85 85 20 18 40 20 26 79 28 50 16

223 166 475 159 479 168 378 155 205 115 246 322

1109

4673

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

10 10 17 42

Leptospiro sis A

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

14 19 11 14 43 22 13 45 36 26 29 17

335

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

Food Poisoning A

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

20 10

July , 2020 Total2020 July, number reporting of units 356 Numberreporting of unitsdata currentprovided forthe week: 323

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

e e 31

Enteric Enteric Fever A

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

17 14 23

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

Encepha litis A

6 8 7 0 8 8 5 0

22 10 21 23 24 21 70 37 10 64 14 12 19 16 15 67 16 45

548

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

Dysentery A refersreturnsto received on befor or

523 149 314 461 122 130 246 303 793 417 382 220 425 647 868

3532 2106 1505 2389 1367 1964 2277 2266 1620

Timeliness

25105

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

72 23 28 97 19 16 12 75 26

419

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 Source: Source: Weekly ofReturns Communicable Diseases(WRCD). SRILANKA

Page 3

WER Sri Lanka - Vol. 47 No. 32 01st– 07th Aug 2020 Table 2: Vaccine-Preventable Diseases & AFP 25th– 31st July 2020 (31st 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 00 00 00 00 00 00 00 25 47 - 46.8 %

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

Mumps 00 00 00 00 00 00 00 00 03 03 12 116 218 - 46.7 %

Measles 00 00 00 00 00 00 00 00 00 00 05 35 215 - 83.7 %

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 13 - 76.9 %

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

Japanese En- 00 00 00 00 02 00 00 00 00 00 00 31 10 210 % cephalitis

Whooping Cough 00 00 00 00 00 00 00 00 00 00 00 05 36 - 86.1 %

Tuberculosis 32 09 30 05 06 20 00 01 05 108 243 3610 5117 - 0 %

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

Dengue Prevention and Control Health Messages

Look for plants such as bamboo, bohemia, rampe and banana in your surroundings and maintain them free of water collection.

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