Aedes aegypti and Aedes albopictus are the vectors The four DENV serotypes (1, 2, 3, and 4) in Sri Lanka >30 years. Main serotypes DEN-2 and 3 - DHF The new genotype of DENV-1 has replaced an old genotype. The emergence of new clades of DENV-3 in recent past coincided with an abrupt increase in the number of dengue fever (DF)/dengue hemorrhagic fever (DHF) cases, implicating in severe epidemics.

1. Dengue Fever
Sri Lanka
W. P. Rivindu H. Wickramanayake
Group no. 04a
5th Year 2nd Semester – 2019 October
Tbilisi State Medical University, Georgia

2.  Since the early 1960s, a major public health issue,
 With a high morbidity and mortality.
 Aedes aegypti and Aedes albopictus are the vectors
 The four DENV serotypes (1, 2, 3, and 4) in Sri Lanka >30 years.
 Main serotypes DEN-2 and 3 - DHF
 The new genotype of DENV-1 has replaced an old genotype.
 The emergence of new clades of DENV-3 in recent past coincided
with an abrupt increase in the number of dengue fever (DF)/dengue
hemorrhagic fever (DHF) cases, implicating in severe epidemics.
Evolution of dengue in Sri Lanka –
changes in the virus, vector, and climate

3.  Climatic factors play a pivotal role in the epidemiological pattern
of DF/DHF in terms of the number of cases, severity of illness,
shifts in affected age groups, and the expansion of spread from
urban to rural areas.
 Close correlation of the occurrence of DF/DHF with the rainfall,
 Peak levels are reached with the south-west monsoon (May to
July) and the north-east monsoon (October to December).
 Medical Research Institute (MRI) indicate that over 90% of the
breeding of Aedes aegypti and Aedes albopictus occurs in small
outdoor containers like tins, coconut shells, bottles, plastic
containers, rubber tyres, etc.

4.  Preponderance in children <15 years, a peak in 5-9 year age group.
 Many cases in 15-29-year age group, especially b/w 15-19 years.
 No any significant male-to female difference.
 To reduce the morbidity and mortality associated with DF/DHF, it is
important to implement effective vector control programs in the
country.
 The economic impact of DF/DHF results from the expenditure on
DF/DHF critical care units in several hospitals and the cost of case
management.
References: Dengue fever and DHF in Sri Lanka. WHO/SEARO, Dengue Newsletter, 18:12.

5. Recent Trends
 From 1 January to 7 August 2017, the Epidemiology Unit of the
Ministry of Health, Sri Lanka reported 122 384 dengue cases, with a
significant number of cases reported from the Western Province
(Approximately - 43%) including 250 deaths.
 The number of cases in 2017 is three-and-a-half times more than
the average number of cases for the same period between 2010
and 2016.
 The Outbreak follows heavy rains and subsequent flooding and
landslides, which affected 600 000 people in 15 of the 25 districts
in the country. (WHO, 11 Jul 2017)

6.  The most affected areas are the; in 2017
 Colombo district, 18,761 cases;
 Gampaha, 12,121 cases;
 Kurunegala, 5,065 cases;
 Kalutara, 4,589 cases and
 Kandy, 4,209 cases.

7. Measures going on
 WHO is providing technical assistance to the Government to control the
dengue outbreak.
 On the request of the Minister of Health, WHO has supported the MOH to
develop a plan to address the dengue outbreak, bring down the caseload and
reduce the case fatality.
 Situation Reports;
1) Situation Report No. 1: 11 July 2017
2) Situation Report No. 2: 17 July 2017
3) Situation Report No. 3: 28 July 2017
 Press Releases;
1) Rapid vector control, personal protection key to curtail dengue

8.  Cases reported in August is reduced to 14,962 when compared to
40,453 cases reported in July. The main reasons for the reduction is
the integrated vector control measures; elimination of breeding
sites, garbage collection, fogging etc. (IFRC, 6 Sep 2017)
 A total of 155,715 suspected Dengue cases have been reported to the
Epidemiology Unit of the Ministry of Health (MOH) of Sri Lanka from
all over the island, for the last 9 months of 2017 with over 320 deaths.
(IFRC, 9 Oct 2017)
 Useful Links / References;
1) http://www.epid.gov.lk/web/index.php?option=com_casesanddeaths&Itemid=448&lang=en
2) WHO Country Office for Sri Lanka: Dengue
3) Sri Lanka Ministry of Health: Distribution of Notification (H399) Dengue Cases by Month

11. Public Health Response
 World Health Organization (WHO) is supporting the MOH Sri Lanka to ensure
an efficient and comprehensive health response and the following response
measures include:
1) Support from the military forces has been requested by the MoH to increase
the number of beds as the health care facilities are overwhelmed. Three temporary
wards in a hospital 38km north of Colombo have now been completed.
2) The MoH launched an emergency response including vector control activities
that is also supported by the mobilization of defense forces. The army, police and civil
defense forces have been mobilized to conduct house-to-house visits in the high-risk
areas with health staff.
In addition, they are involved in mobilizing the community for garbage
disposal, cleaning of vector breeding sites, and in health education.
3) The Regional Office for South-East Asia (SEARO) has constituted a Task
Force to guide the response.

12. 4) WHO/ SEARO deployed an epidemiologist, an entomologist and two dengue
management experts from the WHO Collaborating Center for case management of
Dengue/Dengue Haemorrhagic Fever (Queen Sirikit National Institute of Child Health,
Thailand) and Ministry of Public health (MoPH) Thailand.
5) The triage protocol was updated in June 2017 to assist with better management
of the patients in the health facilities.
 The WHO Sri Lanka country office has purchased 50 fogging machines to
support vector control activities.
 MOH and WHO have worked together to prepare a strategic and operational
plan for intensive measures to control dengue outbreak in next few weeks.
Reference;
1) Emergency Plan of Action operation update Sri Lanka: Dengue by IFRC