Typhoid Vaccination Situation in Sri Lanka Dr Paba Palihawadana MBBS, MSc (Com Med), MPH, MD (Com. Med) Chief Epidemiologist, Ministry of Health, Sri Lanka Epidemiology of Typhoid Fever in Sri Lanka 12, 823 confirmed for the past 10 years in Sri Lanka More than half of these cases (51%) are from 5 districts (Jaffna, Colombo, Vavuniya, Nuwara-Eliya and Badulla). (There are26 health districts in Sri Lanka) No of Typhoid Typhoid Fever Incidence in Sri Lanka Fever cases 2000 1868 1800 1771 1600 1612 1400 1340 1296 1242 1200 1128 1000 987 843 800 736 600 400 Outbreak of Typhoid in IDP camps due to civil unrest in the country 200 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Typhoid Fever Incidence and Incidence Rate in Sri Lanka Incidence Rate (per Year Incidence 100,000 population) 2005 1868 9.12 2006 1612 7.87 2007 1242 6.06 2008 1340 6.54 2009 1771 8.65 2010 1296 6.33 2011 1128 5.51 2012 987 4.82 2013 843 4.12 2014 736 3.59 Outbreak of Typhoid in IDP camps due to civil unrest in the country 18 Age Specific Incidence Rate Age Specific Typhoid Fever Incidence Rates in Sri Lanka 16 2010-2014 14 12 Incidence Rate per 100,000 Highest Incidence 10 in10-15Y age group –(15.6%) 8 83% of cases 6 in 5-50Y age group 4 2 0 Age Category < 2Y 2 -5Y 60-120 10-15Y 15-20Y 20-25Y 25-30Y 30-35Y 35-40Y 40-45Y 45-50Y 50-55Y 55-60Y 5Y-10Y Jaffna 2588 Colombo 1242 Vavuniya 1028 Nuwara-Eli 1010 Badulla 671 Ratnapura 646 Puttalam 561 Typhoid Fever Incidence in Sri Kurunegala 550 Lanka Mannar 518 Kalutara(N 509 by District, 2005-2014 Gampaha 467 Kandy 427 Kegalle 408 Monaragala 386 Matara 262 Matale 238 Batticaloa 196 Kalmunai 162 Polonnaruwa 157 Trincomale 146 Anuradhapu 133 Mullativu 125 Galle 122 Kilinochch 114 Hambantota 99 Ampara 58 0 500 1000 1500 2000 2500 3000 Jaffna 449 Colombo 195 Kalutara(N 109 Gampaha 77 Vavuniya 75 Kegalle 73 Kandy 63 Typhoid Fever Incidence in Sri Lanka Mannar 61 by District, 2013-2014 Ratnapura 60 Kurunegala 50 Kilinochch 44 Batticaloa 41 Matale 34 Matara 32 Nuwara-Eli 30 Monaragala 28 Badulla 27 Puttalam 23 Mullativu 23 Polonnaruwa 19 Ampara 19 Hambantota 17 Trincomale 12 Galle 12 Anuradhapu 6 0 50 100 150 200 250 300 350 400 450 500 Typhoid Fever incidence in Sri Lanka by District, 2005-2014 District Incidence Jaffna 2588 Colombo 1242 Vavuniya 1028 N’Eliya 1010 Badulla 671 Typhoid Fever incidence in Sri Lanka by District, 2013-2014 District Incidence Jaffna 449 Colombo 195 Kaluthara 109 Gampaha 77 Vavuniya 75 Typhoid Fever Incidence Rate in Sri Lanka by District, 2005-2014 District Incidence Rate Vavuniya 59.73 Mannar 52.02 Jaffna 44.32 Nuwara-Eliya 14.19 Mullativu 12.6 Typhoid Fever Incidence Rate in Sri Lanka by District, 2013-2014 District Incidence Rate Jaffna 38.45 Mannar 30.63 Vavuniya 21.79 Kilinochchi 19.38 Mullativu 11.59 Control Strategies adopted in Sri Lanka.. Disease Surveillance Health Education Typhoid Vaccination Water Quality Surveillance Disease Surveillance system in Sri Lanka Typhoid is a notifiable disease under the routine disease surveillance system Every medical practitioner or person professing to treat diseases, who attends on any person suffering from any disease in the notifiable diseases list shall notify the relevant Medical Officer of Health(MOH). Disease Surveillance system in Sri Lanka... Health Districts in Sri Lanka are divided in to Medical Officer of Health (MOH) areas. These MOH areas are headed by one or more medical doctors. There are Public Health Inspectors (PHII) attached to the MOH office, and these PHII carry out disease control activities under the guidance of the MOH Control Strategies adopted in Sri Lanka.. Health Education Typhoid vaccine Inactivated Whole Cell Typhoid vaccine was manufactured in Sri Lanka for over four decades before stopping in 2004 Both injectable Vi capsular polysaccharide vaccine and Ty21a oral vaccine are registered . A total of 268,200 injectable Typhoid vaccines doses were distributed by MoH from 2010- 2014 Sri Lanka is currently using Vi capsular polysaccharide vaccine Typhoid vaccine.. Typhoid vaccine is being administered to Food handlers Pilgrims who visit areas with high Typhoid Fever incidence. Internally displaced persons living in temporary shelters. Close contacts of typhoid patients ( eg. family members) Children getting frequent episodes of diarrhoea (eg. more than 4 attacks in preceding six month) Communities that do not have access to safe water. Health care workers associate with typhoid patients. Pre-Employment administration of Typhoid Vaccine was mandatory in Sri Lanka earlier 1400 160000 Typhoid Incidence Typhoid Fever incidence VS No of Vaccines given Vaccination 140000 1200 Typhoid Incidence No of Vaccines 120000 1000 100000 800 80000 600 60000 400 40000 200 20000 0 0 2010 2011 2012 2013 2014 Water Quality Surveillance in Sri Lanka Water samples are analyzed in the National Reference Laboratory and 5 Regional Laboratories-Since 2011and ongoing 6 Water samples NRL from an MOH area per month Water Quality-2012 Total No of Water samples-3396 Satisfactory 47.08480565 52.91519435 Unsatisfactory Water Quality-2012… Source No of samples Satisfactory (%) Unsatisfactory(%) tested NWS&DB 558 431 (77.2) 127(22.8) CWS 1069 558 (52.2) 511 (47.8) PW 1239 364 (29.4) 875 (70.6) Others 530 246(46.4) 284 (55.6) NWS&DB-National Water Supply and Drainage Board CWS-Community Water Supplies PW-Private Wells Water Quality-2013 Total No of Water samples-4391 49.60145753 Satisfactory 50.39854247 Unsatisfactory Water Quality-2013… Source No of samples Satisfactory (%) Unsatisfactory(%) tested NWS&DB 684 521 (76.1) 163 (23.9) CWS 1254 557 (44.3) 700 (55.7) PW 1214 522 (43.0) 692 (57.0) Others 1236 613 (49.6) 623 (50.4) NWS&DB-National Water Supply and Drainage Board CWS-Community Water Supplies PW-Private Wells Water Quality-2014 Total no of Water Samples-5607 Water Quality-2014 Source No of samples Satisfactory (%) Unsatisfactory(%) tested NWS&DB 744 545 (73.3) 199 (26.7) CWS 1920 909 (46.9) 1031 (53.1) PW 1395 679 (48.7) 716 (51.3) Others 1528 847(55.4) 681 (44.6) NWS&DB-National Water Supply and Drainage Board CWS-Community Water Supplies PW-Private Wells Percentage of satisfactory samples Analysis of Water Samples -2014 100.00% 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% This may be a biased samples-Most of the water samples were collected from Water sources which were suspected of being contaminated Control Strategies adopted in Sri Lanka.. Special surveillance of typhoid in selected sentinel sites hospitals Antibiotic sensitivity patterns are assessed routinely Way forward Strengthening of Sentinel Site Surveillance system and laboratory diagnosis Wider use of antibiotic sensitivity patterns when treating typhoid fever patients Immunization Campaigns in high risk areas for high risk age groups- in Jaffna .