Change in Dengue and Japanese Encephalitis Seroprevalence Rates in Sri Lanka

Background

Sri Lanka has been affected by epidemics of dengue infections for many decades and the incidence and severity of dengue infections have been rising each year. Therefore, we investigated the age stratified seroprevalence of dengue infections in order to facilitate future dengue vaccine strategies. In addition, since the symptomatic dengue infections have increased during the past few decades, we also investigated the possible association with Japanese Encephalitis Virus (JEV) antibody seropositivity with symptomatic dengue in a community cohort in Sri Lanka.

Methods

1689 healthy individuals who were attending a primary health care facility were recruited. Dengue and JEV antibody status was determined in all individuals and JEV vaccination status was recorded.

Results

1152/1689 (68.2%) individuals were seropositive for dengue and only 133/1152 (11.5%) of them had been hospitalized to due to dengue. A significant and positive correlation was observed for dengue antibody seropositivity and age in children (Spearmans R = 0.84, p = 0.002) and in adults (Spearmans R = 0.96, p = 0.004). We observed a significant rise in the age stratified seroprevalence rates in children over a period of 12 years. For instance, in year 2003 the annual seroconversion rate was 1.5% per annum, which had risen to 3.79% per annum by 2014. We also found that both adults (p<0.001) and in children (p = 0.03) who were hospitalized due to dengue were more likely to be seropositive for JEV antibodies. However, 244 (91.4%) of adults who were seropositive for JEV had not had the JEV vaccine.

Conclusions

Dengue seroprevalence rates have risen significantly over the last 12 years in Sri Lanka, possibly due to increased transmission. As individuals who were hospitalized due to dengue were more likely to be seropositive for JEV, the possibility of cross-reactive assays and/or of JEV infection on immunity to the DENV and clinical disease severity should be further investigated.     

Estimates of Dengue Force of Infection in Children in Colombo,Sri Lanka

Dengue is the most important vector-borne viral disease worldwide and a major cause of childhood fever burden in Sri Lanka, which has experienced a number of large epidemics in the past decade. Despite this, data on the burden and transmission of dengue virus in the Indian Subcontinent are lacking. As part of a longitudinal fever surveillance study, we conducted a dengue seroprevalence survey among children aged <12 years in Colombo, Sri Lanka. We used a catalytic model to estimate the risk of primary infection among seronegative children. Over 50% of children had IgG antibodies to dengue virus and seroprevalence increased with age. The risk of primary infection was 14.1% per year (95% CI: 12.7%–15.6%), indicating that among initially seronegative children, approximately 1 in 7 experience their first infection within 12 months. There was weak evidence to suggest that the force of primary infection could be lower for children aged 6 years and above. We estimate that there are approximately 30 primary dengue infections among children <12 years in the community for every case notified to national surveillance, although this ratio is closer to 100∶1 among infants. Dengue represents a considerable infection burden among children in urban Sri Lanka, with levels of transmission comparable to those in the more established epidemics of Southeast Asia.     

Emergence of Epidemic Dengue-1 Virus in the Southern Province of Sri Lanka

BackgroundDengue is a frequent cause of acute febrile illness with an expanding global distribution. Since the 1960s, dengue in Sri Lanka has been documented primarily along the heavily urbanized western coast with periodic shifting of serotypes. Outbreaks from 2005–2008 were attributed to a new clade of DENV-3 and more recently to a newly introduced genotype of DENV-1. In 2007, we conducted etiologic surveillance of acute febrile illness in the Southern Province and confirmed dengue in only 6.3% of febrile patients, with no cases of DENV-1 identified. To re-evaluate the importance of dengue as an etiology of acute febrile illness in this region, we renewed fever surveillance in the Southern Province to newly identify and characterize dengue.Conclusions/SignificanceWe describe the first epidemic of DENV-1 in the Southern Province of Sri Lanka in a population known to be susceptible to this serotype because of prior study. Dengue accounted for 40% of acute febrile illnesses in the current study. The emergence of DENV-1 as the foremost serotype in this densely populated but agrarian population highlights the changing epidemiology of dengue and the need for continued surveillance and prevention.     

Direct Costs of Dengue Hospitalization in Brazil: Public and Private Health Care Systems and Use of WHO Guidelines

Background

Dengue, an arboviral disease, is a public health problem in tropical and subtropical regions worldwide. In Brazil, epidemics have become increasingly important, with increases in the number of hospitalizations and the costs associated with the disease. This study aimed to describe the direct costs of hospitalized dengue cases, the financial impact of admissions and the use of blood products where current protocols for disease management were not followed.

Methods and Results

To analyze the direct costs of dengue illness and platelet transfusion in Brazil based on the World Health Organization (WHO) guidelines, we conducted a retrospective cross-sectional census study on hospitalized dengue patients in the public and private Brazilian health systems in Dourados City, Mato Grosso do Sul State, Brazil. The analysis involved cases that occurred from January through December during the 2010 outbreak. In total, we examined 8,226 mandatorily reported suspected dengue cases involving 507 hospitalized patients. The final sample comprised 288 laboratory-confirmed dengue patients, who accounted for 56.8% of all hospitalized cases. The overall cost of the hospitalized dengue cases was US $210,084.30, in 2010, which corresponded to 2.5% of the gross domestic product per capita in Dourados that year. In 35.2% of cases, blood products were used in patients who did not meet the blood transfusion criteria. The overall median hospitalization cost was higher (p = 0.002) in the group that received blood products (US $1,622.40) compared with the group that did not receive blood products (US $550.20).

Conclusion

The comparative costs between the public and the private health systems show that both the hospitalization of and platelet transfusion in patients who do not meet the WHO and Brazilian dengue guidelines increase the direct costs, but not the quality, of health care.     

宠物鸟·疫病·公共卫生

宠物鸟种类多,来源地广,检验检疫预防措施缺乏,致使宠物鸟疫病不断传播,并造成人类的感染,已经威胁到公共卫生。宠物鸟疫病中以新城疫、禽流感、鹦鹉热最为常见,而且与人类关系密切,具有重要的公共卫生学意义。本文从宠物鸟在疫病流行传播中的意义、疫病的宿主感染谱、疫病的流行特征以及疫病的公共卫生学意义对新城疫、禽流感、鹦鹉热三种疫病进行了综述。表明宠物鸟疫病的感染率比较高,且严重危害人类健康。加强对宠物鸟疫病的检验检疫及预防,很好的防控宠物鸟类疫病具有非常重要的意义。     

Ranging behavior of the Asian elephant in Sri Lanka

We studied the ranging patterns of 10 elephants in and around the Yala protected area complex, southern Sri Lanka, using VHF radio telemetry. All tracked elephants displayed similar ranging patterns. The observed home ranges were small (mean=115.2±64.0 km²) relative to reported home ranges in India, possibly in response to high habitat productivity and abundant perennial water sources. Elephants showed high fidelity to their ranges. Home ranges had relatively large core areas, suggesting intensive use of habitat. No geographically distinct seasonal ranges or migratory behavior was observed. Home range overlap was high, and territoriality was absent. Male musth ranges were considerably larger than non-musth ranges and may signify mate searching. Most elephants ranged both in and outside protected areas, suggesting that resources outside protected areas were important for their survival. Thus, translocating and restricting elephants to protected areas will be detrimental to their survival, as it limits resource access. The ranging patterns of Asian elephants suggest that conservation of the species requires their management both in and outside protected areas.     

A One Health Framework for the Evaluation of Rabies Control Programmes: A Case Study from Colombo City,Sri Lanka

Background

One Health addresses complex challenges to promote the health of all species and the environment by integrating relevant sciences at systems level. Its application to zoonotic diseases is recommended, but few coherent frameworks exist that combine approaches from multiple disciplines. Rabies requires an interdisciplinary approach for effective and efficient management.

Methodology/Principal Findings

A framework is proposed to assess the value of rabies interventions holistically. The economic assessment compares additional monetary and non-monetary costs and benefits of an intervention taking into account epidemiological, animal welfare, societal impact and cost data. It is complemented by an ethical assessment. The framework is applied to Colombo City, Sri Lanka, where modified dog rabies intervention measures were implemented in 2007. The two options included for analysis were the control measures in place until 2006 (“baseline scenario”) and the new comprehensive intervention measures (“intervention”) for a four-year duration. Differences in control cost; monetary human health costs after exposure; Disability-Adjusted Life Years (DALYs) lost due to human rabies deaths and the psychological burden following a bite; negative impact on animal welfare; epidemiological indicators; social acceptance of dogs; and ethical considerations were estimated using a mixed method approach including primary and secondary data. Over the four years analysed, the intervention cost US $1.03 million more than the baseline scenario in 2011 prices (adjusted for inflation) and caused a reduction in dog rabies cases; 738 DALYs averted; an increase in acceptability among non-dog owners; a perception of positive changes in society including a decrease in the number of roaming dogs; and a net reduction in the impact on animal welfare from intermediate-high to low-intermediate.

Conclusions

The findings illustrate the multiple outcomes relevant to stakeholders and allow greater understanding of the value of the implemented rabies control measures, thereby providing a solid foundation for informed decision-making and sustainable control.     

Constraints to the implementation of biological control in Sri Lanka

Sri Lanka is a tropical island with a rich diversity of arthropods, with many species of indigenous natural enemies of economic pests. However, no extensive island wide surveys have been carried out for natural enemies of major crop ecosystems and only a few of the indigenous natural enemies are reported useful for augmentation biological pest control by massive field releases of laboratory-produced insects. Most successful biological control programs on the island are importation (i.e. classical) biological control programs, where established exotic natural enemies control certain pest populations in valuable crops. There is growing interest in the use of native natural enemies in pest management, thus creating a need for intensive research on the ecology of indigenous natural enemies and development of infrastructure and technology to produce natural enemies for augmentation. This paper examines constraints and opportunities for implementation of biological control in Sri Lanka.     

Relationship between nutritional status and tooth loss in an older population from Sri Lanka

doi: 10.1111/j.1741‐2358.2011.00518.x Relationship between nutritional status and tooth loss in an older population from Sri Lanka Objective: To determine the relationship between tooth loss and nutritional status in older individuals in Sri Lanka. Background: In developing countries, both the prevalence of malnutrition and oral disease are high among older individuals. Materials and methods: Four hundred and eighty subjects aged 60 years and above were selected to be included in the sample, of which 437 responded giving an overall response rate of 91%. Data were collected by means of an interviewer administered questionnaire, an oral examination and a physical examination to determine height and weight to calculate the body mass index (BMI). Results: Based on the WHO cut‐offs for BMI, 62, 20 and 18% of the sample were normal, under‐ and over‐weight, respectively. A multinomial logistic regression analysis with normal weight as the reference category revealed that missing teeth and denture status were associated with being underweight but not with being overweight. Conclusion: In older individuals, tooth loss is significantly associated with being underweight.     

Spatio-Temporal Dynamics of Cholera during the First Year of the Epidemic in Haiti

Background

In October 2010, cholera importation in Haiti triggered an epidemic that rapidly proved to be the world''s largest epidemic of the seventh cholera pandemic. To establish effective control and elimination policies, strategies rely on the analysis of cholera dynamics. In this report, we describe the spatio-temporal dynamics of cholera and the associated environmental factors.

Methodology/Principal findings

Cholera-associated morbidity and mortality data were prospectively collected at the commune level according to the World Health Organization standard definition. Attack and mortality rates were estimated and mapped to assess epidemic clusters and trends. The relationships between environmental factors were assessed at the commune level using multivariate analysis. The global attack and mortality rates were 488.9 cases/10,000 inhabitants and 6.24 deaths/10,000 inhabitants, respectively. Attack rates displayed a significantly high level of spatial heterogeneity (varying from 64.7 to 3070.9 per 10,000 inhabitants), thereby suggesting disparate outbreak processes. The epidemic course exhibited two principal outbreaks. The first outbreak (October 16, 2010–January 30, 2011) displayed a centrifugal spread of a damping wave that suddenly emerged from Mirebalais. The second outbreak began at the end of May 2011, concomitant with the onset of the rainy season, and displayed a highly fragmented epidemic pattern. Environmental factors (river and rice fields: p<0.003) played a role in disease dynamics exclusively during the early phases of the epidemic.

Conclusion

Our findings demonstrate that the epidemic is still evolving, with a changing transmission pattern as time passes. Such an evolution could have hardly been anticipated, especially in a country struck by cholera for the first time. These results argue for the need for control measures involving intense efforts in rapid and exhaustive case tracking.     

Cessation of childbearing in the absence of contraception in Sri Lanka

In data from the Sri Lanka Fertility Survey, 1975, the cessation of childbearing is examined among women who have never used contraception. The sample consisted of 6810 currently or previously married women, 57% of whom reported that they had never used contraception. Cessation of childbearing is studied according to age and marriage duration. The variables analyzed are age at last birth, proportions infertile during the last 5 or 7 years, and the infertile open interval. The duration of breastfeeding is taken into account where necessary, and the contraceptive users and nonusers are compared where appropriate. Non-users tend to cease childbearing early, and therefore are infertile for longer periods during their marriages. It is probably age of the 1st child that influences decisions on future fertility. Among women aged 45-49 who married before age 20 and continued in their 1st marriage, mean age at last live birth in non-users, was 34.5 years, about 2 years earlier than in those who had used contraception. Non-users who married at any age below 30 years cease childbearing well below age 40. The proportion not currently pregnant and infertile over the past 5 years increases with marriage duration among the fertile non-users in each age group. When age at last birth and the duration of breastfeeding in the open interval are taken into account and the reference period is increased to 7 years, the period of infertility increases with marriage duration among nonpregnant non-users below age 45. The proportion of women who were currently not pregnant and had remained infertile over the past 7 years is higher among the older non-users whose 1st child was born more than 10 years ago.     

Anthropophagy and aggregation behaviour of the sandfly Phlebotomus argentipes in Sri Lanka

ABSTRACT. The visceral leishmaniasis (VL) vector Phlebotomus argentipes Annandale & Brunetti is widely distributed throughout the Indian sub-continent and S.E. Asia. The absence of VL in areas such as Sri Lanka has been attributed to the zoophilic nature of P.argentipes , since they were not recorded biting man.
Field studies on P. argentipes were undertaken in the central highlands of Sri Lanka, near Kandy, in May 1988. Male sandflies outnumbered females on cows by 19:1, and were regularly spaced at all densities. This behaviour is considered analagous to swarming in other Nematocera. However, all-night human-biting catches show the biting rate to be similar (mean=8.4, range 2–25 bites per night over ten consecutive nights) to that in N.E. India where VL is endemic. This anthropophagy was maintained during laboratory colonization.     

Comparative studies of vegetative anatomy in the Theaeeae of Sri Lanka

Anatomical characters of the mature leaf blade, petiole, young stem and wood were examined in order to substantiate taxonomic boundaries between genera and species of Theaeeae in Sri Lanka. Two species of Temstroemia , one of Adinandra , four of Eurya and two of Gordonia were studied.
The presence of sclereids in most organs of the plant was found to be a common character within the family. However, three distinct types of sclereid are reported. Two basic types of stomata, anomocytic and gordoniaceous, are recognized. The origin of phellogen in the young stems is pericyclic in Gordonia and subepidermal in the other three genera. The species within these genera also appear to have several distinctive characters of their own. Important wood characters have been tabulated in order to illustrate the primitive and advanced characters. Gordonia , especially, exhibits anatomical features which are quite different from those of Temstroemia, Adinandra send Eurya.     

Resource partitioning among the fishes of rainforest streams in Sri Lanka

The fish assemblage typical of small rainforest streams of Sri Lanka was investigated to see if the fishes were characterized by a high degree of specialization, expected of equilibrium communities, or if they were relatively unspecialized, expected of more stochastic (non-equilibrium) communities. Morphological features, habitats, microhabitats and diets of the 20 most abundant fish species were measured. The fishes included 11 Cyprinidae (including seven Barbus spp. and two Rasbara spp.), two Gobiidae, two Channidae, and one species each in the Cobitidae, Cyprinodontidae, Belontidae, Belonidae, and Mastacembelidae. Microhabitats were determined by measuring (for 6760 fish) water column depth, distance of fish from bottom, mean water column velocity, water velocity at fish, and substrate. Morphologically, the species showed a high degree of specialization, especially in structures related to feeding. Although several species were habitat generalists, most species occurred in distinct habitats. Within habitats, microhabitat overlap among co-occuring species was low, particularly in relation to position in the water column. Principal component analysis of the microhabitat measurements produced three new variables. Most species not clearly segregated by the overlap analysis showed segregation on the new variables. Fishes not segregated by habitat or microhabitat tended to show low dietary overlaps. Specialization in feeding habits was more pronounced among the Sri Lankan fishes than noted for fishes in small rainforest streams elsewhere, in part because of the greater reliance of the Sri Lanka fishes on autochthonous foods. Overall, the fish assemblage had the characteristics expected of an equilibrium (deterministic) assemblage.     

Population dynamics of anthropophilic mosquitoes during the northeast monsoon season in the malaria epidemic zone of Sri Lanka

Abstract. Mosquito-borne diseases are a major health problem in Sri Lanka. Human biting mosquitoes were collected during the night (18.00–06.00 hours) at Nikawehera village, in the malaria endemic intermediate rainfall zone of the country. Collections were made at monthly intervals in the period October 1991 to April 1992, which included the main rainy season due to the northeast monsoon (October-January). Thirteen Anopheles , eleven Culex , three Aedes , three Mansonia and one Armigeres species were identified, including known vectors of malaria, Bancroftian filariasis, Japanese encephalitis and dengue fever. Mosquito human-biting rates were highest in December. The main malaria vector Anopheles culicifacies showed peak biting between 18.00 and 23.00 hours whereas the predominant culicines Culex fuscocephala and Cx quinquefasciatus preferred to bite after midnight. In 1991-92 the prevalence of some species of anophelines at Nikawehera differed markedly from that observed in 1990-91 and the possible reasons are discussed.     

Reproductive tactics of the Asian cichlids of the genusEtroplus in Sri Lanka

Synopsis The Asian cichlids,Etroplus maculatus (the orange chromide) and E. suratensis (the green chromide) in Sri Lanka reproduce twice during the year when water conditions are favorable for nest construction and maintaining visual contact with offspring. These are the drier premonsoonal and monsoonal seasons when water turbidity decreased and salinity increased. When breeding in isolation orange chromide pairs selected dense vegetation where nests were camouflaged. During the peak breeding cycle (July) orange chromide pairs selected sparse vegetation for nesting as a compromise between survival of young and availability of adult food. These areas were also occupied by foraging non-breeding conspecifics which increased the threat of cannibalism of offspring. Under these pressures most orange chromides nested in colonies which helped decrease both actual and attempted cannibalism. The sympatric green chromide does not forage during nesting and nest site selection was determined mainly by factors favoring offspring survival. Biparental care is exhibited by both species. One member of an orange chromide pair stands guard over offspring while the other leaves the territory to forage — their roles are reversed every few minutes. The total parental investment is equivalent to the full investment of a single parent. Monogamy appears to be maintained by their metabolic constraints. In the green chromide both parents are vigilant over offspring and neither forages thus spending twice as much time in parental investment.