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. 44 No. 41 07th– 13th October 2017 Melioidosis (Whitmore's Disease) damaged skin. Melioidosis is an infectious disease caused by a bacterium called Burkhold- Melioidosis occurs throughout the year eria pseudomallei. The bacteria are in Sri Lanka with increasing prevalence found in contaminated water and soil during rainy weather, during floods and and spread to humans and animals other natural disasters. Infection occurs through direct contact with the contami- in all age groups, including children and nated source. Melioidosis is endemic in in both sexes but the highest incidence the tropical and subtropical zones of is seen in middle aged males. Risk fac- South East Asia and Northern Australia. tors for the disease include occupation- Although Sri Lanka is not considered as al exposure to contaminated water and a country where melioidosis is endemic, mud, especially by working in paddy an increasing number of cases have fields which are suitable environmental been reported recently. The first pub- conditions that prevail in Sri Lanka. In lished report of melioidosis in Sri Lanka addition, military personnel, adventure was in 1927 in a European tea broker travelers, workers in construction sites, resident in Sri Lanka. People acquire fishing, and forestry belong to the high the disease by inhaling dust contami- risk group. Malaysia and Thailand have nated by the bacteria and when the reported the organism in deforestated, contaminated soil comes in contact with irrigated and cultivated areas.

Contents Page

1. Leading Article – Food Safety 1 2. Summary of selected notifiable diseases reported - (30th– 06th September 2017) 3 3. Surveillance of vaccine preventable diseases & AFP - (30th– 06th September 2017) 4

WER Sri Lanka - Vol. 44 No. 41 07th – 13th October 2017 Symptoms ops pneumonia or septic shock upon returning from tropical or subtropical areas, the doctors need to There are no unique symptoms in Melioidosis. Pa- consider Melioidosis as a possible diagnosis. tients with the disease usually have fever. Symp- Avoid contact with soil and stagnant water if toms most commonly affect lungs and the effects you have open wounds, diabetes, or chronic can range from mild bronchitis to severe pneumo- kidney disease. nia. As a result, patients also may experience Be vigilant about avoiding exposure by inhala- headache, and loss of appetite, cough, chest pain, tion during severe weather events (floods/ and general muscle soreness. The infection can heavy rains). also be localized to infection on the skin (cellulites) Healthcare workers should wear masks, gloves, with associated fever and muscle aches. It can and gowns. spread from the skin through the blood to become Meat cutters and processors should wear a chronic form of melioidosis affecting the heart, gloves and disinfect knives regularly. brain, liver, kidneys, joints and eyes. People with If drinking dairy products, be sure they are pas- Diabetes mellitus, renal disease, liver disease or teurized. alcoholism are most likely to get the severe form of Get screened for melioidosis if you’re about to the infection. The disease may be mistaken for oth- start immunosuppressive therapy. er fevers such as Dengue or Leptospirosis. It is Further clinical and epidemiological studies are very rare for people to get the disease from another needed to identify the real burden of Melioidosis in person even though a few cases have been docu- Sri Lanka. mented.

Sources Diagnosis 1.Melioidosis, available at http://www.nejm.org/doi/ A diagnosis of B. pseudomallei infection requires pdf/10.1056/ NEJMra1204699 both clinical suspicion and supporting laboratory 2.Melioidosis in Sri Lanka, Available at http:// evidence. The variety of clinical manifestations of sljid.sljol.info/ articles/abstract/10.4038/ infection makes melioidosis difficult to diagnose sljid.v2i1.3801/ . Compiled by clinically. The definitive diagnosis depends on the 3. Available at https://www.healthline.com/health/ isolation and identification of B. pseudomallei from melioidosis clinical specimens (blood, urine, sputum or skin- Dr. A.M.U.Prabha Kumari of the Epidemiology Unit lesion sample). A delay in diagnosis can be fatal, since empirical antibiotic regimens used for sus- pected bacterial sepsis often do not provide ade- quate coverage for B. pseudomallei. A direct poly- merase-chain-reaction assay of a clinical sample may provide a more rapid test result than culture, but the assay is less sensitive, especially when per- formed on blood. Serologic testing alone is inade- quate for confirming the diagnosis, especially in endemic regions where the background seroposi- tivity rate can be more than 50%. There are well established antibiotic treatment guidelines for the treatment of Melioidosis and relapses may occur mostly in people who don’t complete the full course of antibiotics. A careful search for internal-organ abscesses such as with the use of computed to- mography or ultrasonography of the abdomen and pelvis is recommended. Adjunctive therapy for ab- scesses includes drainage of collections, aspiration and washout of septic joints.

Prevention

Melioidosis is a potentially preventable disease. There are no vaccines for humans to prevent the disease and people who live in or are visiting areas where Melioidosis is common should take following action to prevent the infection. If a traveler devel-

Page 2 WER Sri Lanka - Vol. 44 No. 41 07th – 13th October 2017

Table 1: Selected notifiable diseases reported by Medical Officers of Health 30th– 06th Oct 2017 (40thWeek)

94 88 99

C**

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

7 2 8 7 4 7

WRCD

13 10 21 13 59 17 10 10 42 24 16 13 23 33 19 11 11 28 11 12 16

T*

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

10 11 10 13 17 21

316 129 132 210 116

B

1019

0 0 0 0 0 0 0 0 1 3 0 0 0 0 1 0 0 0 3 0 9 4 0 0 0 0

A

21

Leishmania- sis

8 0 3 5

53 61 26 27 34 39 61 19 34 10 27 40 23 65 40 65 18 64 29

129 180 138

B

1198

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

22

A

Meningitis

3

44 14 31 16 85

250 308 239 452 213 266 335 175 201 170 157 166 140 432 131 338 199 323 256 128

B

5072

Completeness

-

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

C**

10

78

A

Chickenpox

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

B

14

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

A

Human Human Rabies

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

12 14 14 11 12 18 17 18 13 53 19 71

B

335

Viral Viral

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

7

Hepatitis

A

2 2 7 3 9 4 0 1 7 0

67 12 64 63 23 15 12 25 11 18 28

115 159 414 103 115

B

1279

Fever

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

Typhus

A

25

4 2 9

30 87 51 44 49 43 28 26 19 22 17 23 60 26 62 37

113 289 308 176 109 116 514

B

2264

s

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

A

14 17

Leptospirosi

64

8 1 1 6 5 1 9 8 5 9 8

10 22 32 52 10 53 16 24 14 55 24 21 54 15

B

284

747

Food Food

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

6

A

Poisoning

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

25 16 16 31 19 34 11 67 15 12 13

B

318

Fever

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

8

Enteric Enteric

A

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

12 13 13 21 10 78

October, 2017 Total number reportingof units344 Number reportingof units dataprovided forthe current week: 341

B

th

230

s

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

4

A

Encephaliti

8

20 33 51 29 49 61 24 44 21 32 24 19 15 34 30 75 46 34 17 96 63 91

289 125 138

B

1468

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

Dysentery

14 10

A

56

810 447 509 794 320 811

2595 8868 9617 5489 3026 5844 4187 4665 4729 9654 5279 2506 1225 3256 2323 2236

refersreturnsto received on before or 06

B 30925 28777 11929 10548

161369

Timeliness

6 6 2 7 6 9

30 93 67 31 47 50 26 11 16 62 14 25 61 78 28

T=

*

Dengue Fever Fever Dengue

207 206 183 126 111

A

1508

RDHS RDHS

Division

SRILANKA

Colombo Gampaha Kalutara Kandy Matale NuwaraEliya Galle Hambantota Matara Jaffna Kilinochchi Mannar Vavuniya Mullaitivu Batticaloa Ampara Trincomalee Kurunegala Puttalam Anuradhapur Polonnaruwa Badulla Monaragala Ratnapura Kegalle Kalmune Source: Source: esurveillance.epid.gov.lk Page 3

WER Sri Lanka - Vol. 44 No. 41 07th – 13th October 2017 Table 2: Vaccine-Preventable Diseases & AFP 30th– 06th Oct 2017 (40thWeek) Number of Number of Total Difference cases cases Total num- No. of Cases by Province number of between the during during ber of cases cases to number of Disease current same to date in date in cases to date week in week in 2016 2017 in 2017 & 2016 W C S N E NW NC U Sab 2017 2016

AFP* 00 01 00 00 00 00 00 01 01 03 00 53 53 0%

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

Mumps 01 01 00 00 00 00 00 02 00 04 03 247 304 - 18.7%

Measles 01 00 00 00 00 00 00 00 00 01 10 175 340 - 48.5%

Rubella 00 00 00 00 00 00 00 00 00 00 00 10 08 25%

CRS** 00 00 00 00 00 00 00 00 00 00 00 01 00 0%

Tetanus 00 00 00 00 00 00 00 00 00 00 00 16 08 100%

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 00 21 15 40% cephalitis

Whooping 00 00 00 00 00 00 00 00 00 00 02 18 56 - 67.8% Cough

Tuberculosis 91 15 11 13 13 40 14 04 31 232 154 6493 7164 -9.3%

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 Dengue Prevention and Control Health Messages

Look for plants such as bamboo, bohemia, rampe and banana in your surroundings and maintain them

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