Seroprevalence of Toxoplasma gondii in cats from Colombo, Sri Lanka

Cats are essential in the life cycle of Toxoplasma gondii because they are the only hosts that can excrete the environmentally resistant oocysts in nature. Nothing is known of the prevalence of Toxoplasma gondii in cats from Sri Lanka. Serum samples from 86 cats from Colombo, Sri Lanka, were tested for antibodies to T. gondii using the modified agglutination test; antibodies were found in 26 (30.2%) cats with titers of 1:25 in 4, 1:50 in 4, 1:100 in 3, 1:400 in 2, 1:800 in 3, 1:1,600 in 4, and 1:3,200 or higher in 6 cats. Seropositivity increased with age and was higher in stray cats versus pet cats. This is the first report of seroprevalence of T. gondii in cats from Sri Lanka.     

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.     

Laboratory-Enhanced Dengue Sentinel Surveillance in Colombo District,Sri Lanka: 2012-2014

Introduction

Dengue has emerged as a significant public health problem in Sri Lanka. Historically surveillance was passive, with mandatory dengue notifications based on clinical diagnosis with only limited laboratory confirmation. To obtain more accurate data on the disease burden of dengue, we set up a laboratory-based enhanced sentinel surveillance system in Colombo District. Here we describe the study design and report our findings of enhanced surveillance in the years 2012–2014.

Methods

Three outpatient clinics and three government hospitals in Colombo District that covered most of the Colombo metropolitan area were selected for the sentinel surveillance system. Up to 60 patients per week presenting with an undifferentiated fever were enrolled. Acute blood samples from each patient were tested by dengue specific PCR, NS1 ELISA and IgM ELISA. A sub-set of samples was sent to Duke-NUS Singapore for quality assurance, virus isolation and serotyping. Trained medical research assistants used a standardized case report form to record clinical and epidemiological data. Clinical diagnoses by the clinicians-in-charge were recorded for hospitalized cases.

Results

Of 3,127 febrile cases, 43.6% were PCR and/or NS1 positive for dengue. A high proportion of lab confirmed dengue was observed from inpatients (IPD) (53.9%) compared to outpatient (clinics in hospitals and general practice) (7.6%). Dengue hemorrhagic fever (DHF) was diagnosed in 11% of patients at the time of first contact, and the median day of illness at time of presentation to the sentinel sites was 4. Dengue serotype 1 was responsible for 85% of the cases and serotype 4 for 15%. The sensitivity and specificity of the clinicians’ presumptive diagnosis of dengue was 84% and 34%, respectively.

Conclusion

DENV-1, and to a lesser degree DENV-4, infection were responsible for a high proportion of febrile illnesses in Colombo in the years 2012 to 2014. Clinicians’ diagnoses were associated with high sensitivity, but laboratory confirmation is required to enhance specificity.     

Infant mortality in Sri Lanka

Infant mortality in Sri Lanka declined substantially between 1961 and 1980, the reduction being higher during the post-natal period. 3 distinct phases were identified: 1) a declining trend in the face of several fluctuations; 2) a sharp reversal of the trend and then an increase; and 3) a more consistent decline. Between the periods 1961-65 and 1976-80, deaths from exogenous and endogenous causes were reduced considerably and nearly equally. The probabilities of survival increased in every age group, proportionally more in the 1st week of life. There was no evidence that changes in national income or total food supply were factors, but protein calorie availability appeared to affect the rate. Distribution of free supplementary food, increase in public health personnel, more immunization, and a rise in the number of institutional births appeared to have initiated and sustained the more recent decline in infant mortality. Increasing levels of female education also augmented these developments. Further efforts to improve living conditions, access to safe water and flush or water-seal toilets, and motivating women to deliver in institutions and extend their postnatal stay, would probably result in a further decline, as well as general strategies such as integrating public health and medical services and improving health education programs.     

Enterotoxigenic staphylococci in Sri Lanka

Two hundred and ninety-three strains of Staphylococcus aureus isolated from clinical specimens were tested for enterotoxigenicity by the Optimum Sensitivity Plate (OSP) method. Thirty-nine per cent produced enterotoxins A, B, C, D or E. Enterotoxin B was detected more often than the others. The OSP technique was found to be satisfactory for the detection of enterotoxigenic staphylococci.     

Manipulating Meaning in Sri Lanka

Exploring Confrontation: Sri Lanka: Politics, Culture and History. Michael Roberts
"Who Is He, What Is He Doing": Religious Rhetoric and Performances in Sri Lanka during R. Premadasa's Presidency (1989-1993).     

Ethnic conflict in Sri Lanka

Social Scientists’ Association, ETHNICITY AND SOCIAL CHANGE IN SRI LANKA, Karunaratne & Sons, Colombo, 1984, 202 pp., 25 Rs.     

Seroprevalence of Toxoplasma gondii in wild toque macaques (Macaca sinica) at Polonnaruwa, Sri Lanka

From a natural population that inhabits the dry evergreen forest at Polonnaruwa, serum samples of 170 toque macaques were examined for antibodies to Toxoplasma gondii by the modified agglutination test. Of these, 21 (12%) were found with titers of 1:16 in 9, 1:32 in 9, 1:256 in 1, 1:1,024 in 1, and 1:4,096 in 1. There was no evidence of maternal transmission of antibodies or congenital toxoplasmosis. None of the infected macaques died within 1 yr after sampling. Toxoplasma gondii infection was closely linked to human environments where domestic cats were common. Macaques having frequent contact with human settlements showed a significantly greater (P < 0.0001) prevalence (19% infected) than macaques restricted to forest habitat, none of which was infected. Although infection with T. gondii has been noted in several species of Asian primates, this is the first report of T. gondii antibodies in toque macaques (Macaca sinica) that are endemic to the island of Sri Lanka.     

Costs of Dengue Control Activities and Hospitalizations in the Public Health Sector during an Epidemic Year in Urban Sri Lanka

Background

Reported as a public health problem since the 1960s in Sri Lanka, dengue has become a high priority disease for public health authorities. The Ministry of Health is responsible for controlling dengue and other disease outbreaks and associated health care. The involvement of large numbers of public health staff in dengue control activities year-round and the provision of free medical care to dengue patients at secondary care hospitals place a formidable financial burden on the public health sector.

Methods

We estimated the public sector costs of dengue control activities and the direct costs of hospitalizations in Colombo, the most heavily urbanized district in Sri Lanka, during the epidemic year of 2012 from the Ministry of Health’s perspective. The financial costs borne by public health agencies and hospitals are collected using cost extraction tools designed specifically for the study and analysed retrospectively using a combination of activity-based and gross costing approaches.

Results

The total cost of dengue control and reported hospitalizations was estimated at US$3.45 million (US$1.50 per capita) in Colombo district in 2012. Personnel costs accounted for the largest shares of the total costs of dengue control activities (79%) and hospitalizations (46%). The results indicated a per capita cost of US$0.42 for dengue control activities. The average costs per hospitalization ranged between US$216–609 for pediatric cases and between US$196–866 for adult cases according to disease severity and treatment setting.

Conclusions

This analysis is a first attempt to assess the economic burden of dengue response in the public health sector in Sri Lanka. Country-specific evidence is needed for setting public health priorities and deciding about the deployment of existing or new technologies. Our results suggest that dengue poses a major economic burden on the public health sector in Sri Lanka.     

Buddhist Fundamentalism and Minority Identities in Sri Lanka

Buddhist Fundamentalism and Minority Identities in Sri Lanka. Tessa J. Bartholomeusz and Chandra R. de Silva. eds. Albany: State University of New York Press, 1998. 212 pp.     

The Musca domestica complex in Sri Lanka

An account is given of samples of houseflies taken from various natural populations in Sri Lanka (Ceylon) to investigate the number of evolutionary forms of housefly that may occur on the island. The results are related to the formal taxonomy of the genus Musca.     

Decreases in Both the Seroprevalence of Serum Antibodies and Seroprotection against Japanese Encephalitis Virus among Vaccinated Children

The incidence of Japanese encephalitis(JE) has significantly decreased in China due to JE vaccines. In this study, we investigated the post-JE vaccination seroprevalence and protection provided by vaccinated sera against Japanese encephalitis virus(JEV) to elucidate the persistence and waning of antibodies to JEV among JE-SA14-14-2-vaccinated children. A total of 300 serum samples were collected from vaccinated children aged 3–10 years in Zhaotong, Yunnan,China. The seroprevalence of anti-JEV antibodies was determined by enzyme-linked immune sorbent assay and plaque reduction neutralization test. The highest seropositivity of 82% was observed in vaccinated children during the first0.5–1.5 years after booster vaccination. Then, the seropositivity began to decline and remained lower than the original level observed in the 0.5–1.5-year group. An association was found between the waning of seroprevalence and elapsed time of the post-booster vaccination. Similarly, the neutralizing antibody(nAb) titres gradually decreased over time, and the levels showed a positive correlation with the protective efficacy in mice. This finding suggests that nAbs play an important role in the antiviral process and that the nAb titre is an adequately credible parameter for evaluating the protective efficacy induced by the JE vaccine. Our results provide data that clarify the persistence and waning of antibodies to JEV, which may help elucidate the pathogenesis of JE.     

Malaria outbreaks in new foci in Sri Lanka

During its Malaria Eradication Programme (1958-1964) Sri Lanka spectacularly reduced its malaria incidence from around half a million per year to 17. Regrettably, this magnificent achievement could not be maintained, and malaria once again reached epidemic proportions in some areas. Of particular concern however, has been the emergence of new foci of malaria around the hill capital, Kandy, discussed here by Manel Wijesundera. The new outbreaks seem intimately related to hydrological changes brought about by major irrigation and hydroelectric schemes on the Mahaweli river. The priority for such schemes is not, of course, to flush out the pools where mosquito larvae thrive, but to divert water for irrigation and power generation. In parallel, human migration between malaria endemic and non-endemic areas - stimulated by the resettlement required by the dam reservoirs - has contributed to increased malaria transmission. In a sense therefore, this story is a classic of health impact overlooked in favour of agricultural and industrial development. But whereas most documented cases relate to extensive flooding causing an increase in vector breeding sites and so exacerbating disease transmission, this story is just the opposite. Here, it is reduction in water flow that has promoted an increase in vector breeding.     

Compensatory payments and vasectomy acceptance in urban Sri Lanka

The effects of different levels of compensatory payment for vasectomy on sterilization acceptance were examined in 496 vasectomized men in urban Sri Lanka. The results indicate that compensatory payments significantly enhanced the participation of economically poor men in vasectomy programs, especially those who had already achieved a large family size. The proportion of poor acceptors (those with a monthly income of Rs 1000 or less) increased with higher levels of payment; the acceptor's level of education was negatively correlated with the compensation amount, and the mean age of the youngest child was higher among those who received higher payments. 60% of vasectomy acceptors reported using contraception immediately before the vasectomy, suggesting a high level of motivation not to have another child. Respondents cited high effectiveness, no extra expense, and no side effects for their wives as the main reasons for selecting vasectomy over other means of contraception, regardless of the amount of payment received. Only 5% said cash payment was an important reason for choosing vasectomy, and this response did not vary significantly by level of payment. There was no influence of payment level on postoperative complications or satisfaction. While compensatory payments significantly enhanced the participation of poor men in vasectomy programs, they were not effective in attracting poorer men with few children or those whose last child was relatively young. Overall, this study's findings suggest that the decision to provide compensatory payments and how much to provide should be based on economic and political factors, not on the grounds that higher compensatory payments have led to the recruitment of ineligible men or that the promotion of vasectomy has been at the expense of a loss in the quality of services provided.     

Environmental and other factors influencing fertility in Sri Lanka

The study utilizes the complete tabulations from the 1971 census and data from the Registrar General's and Meteorological departments for the same year. It applies a multiple regression analysis of the total fertility rate for each district for 1971 on a series of environmental variables. These include the proportion of the rural population by district to the all-island rural population; the district mean annual rainfall and the proportion of the district population employed in the major rural occupations to the total employed. To these 3 environmental variables were added 2 socioeconomic variables: the proportion of the population aged 10+ years and who are literate, and infant mortality. Results indicate that the 5 independent variables are clearly intercorrelated. The multiple regression analysis shows that the 5 variables together account for 76.4% of the total variation in district total fertility rate. It is argued that this and other studies undertaken previously provide useful pointers to the type of variable to be considered in any policy aimed at population control and indicate where major efforts should be directed.     

Establishing a twin register in Sri Lanka.

Nearly all twin registers are based in developed countries and there is no twin register in the developing world. Our objectives were to initiate the process of establishing a nationwide twin register in Sri Lanka by starting a volunteer register first and working towards a population-based register. Regular newspaper advertisements, feature articles, radio talks, and television programmes were used to publicise a competition for twins, their parents/relatives and friends requesting them to participate by sending in details of twins. The competition ran from 28 March 1997 for a period of 3 months. It offered prizes for three winners selected by drawing lots. Advertisements highlighted the objective of the competition as establishing a twin register for future research and emphasised that informed consent would be obtained for individual research projects. Those who registered comprise 4602 twin pairs (same sex: male--1564, female--1885; different sex--1153), 80 sets of triplets (same sex: male--17, female--31; different sex--42) and two sets of quadruplets (different sex). The oldest twins, triplets, quadruplets are 85, 46, and 5 years old, respectively; 88.0% of twins are less than 30 years old. Although others have previously used media publicity to enrol twins in twin registers, we believe this to be the first time that twins have been enrolled through competition. We have more young twins, and our gender and zygosity proportions after applying Weinburg's rule do not match the proportions expected from a volunteer twin sample. Establishing a twin register for research purposes has proved possible in a developing country.     

Fungi associated with dried fish in Sri Lanka

The mycoflora of dried-salted fish from markets in Kandy, Sri Lanka was studied with emphasis on visibly spoiled dried fish. A total of 61 fungal isolates from 25 dried-fish were isolated and identified. The most prevalent fungus wasAspergillus niger. Species ofAspergillus flavus, A. fumigatus, A. glaucus, A. restrictus, Aureobasidium spp.Basipetospora halophila (a genuinely halophilic fungus)Cladosporium herbarum, Gliomastix, spp.,Penicillium chalybeum andPenicillium expansum were present. The isolated fungi did not grow in synthetic media containing more than 30% sodium chloride.Aureobasidium spp. andGliomastix spp. did not grow on dried-fish under laboratory conditions. The protective exoskeleton appeared to prevent fungal growth on dried shrimp. TheA. flavus strains isolated were not aflatoxigenic.     

Parasitic infections in freshwater ornamental fish in Sri Lanka

A total of 1520 ornamental fish of 13 species from 26 export farms in Sri Lanka were collected between October 1999 and March 2000 and examined for parasites. Fish species examined were guppy Poecilia reticulata, goldfish Carassius auratus, platy Xiphophorus maculatus, molly Poecilia sphenops, angel Pterophyllum scalare, swordtail Xiphophorus helleri, tetras Hyphessobrycon species, barbs Capeota and Puntius spp., gourami Colisa sp., carp Cyprinus carpio, fighters Betta spelendens and others (Brachydanio and Astronotus spp.). Nine species of monogenean trematodes (Dactylogyrus extensus, Dactylogyrus cf. extensus, D. vastator, Dactylogyrus cf. vastator Dactylogyrus spp., Gyrodactylus turnbulli, G. katherineri, Gyrodactylus cf. katherineri, Gyrodactylus spp.), 7 protozoan species (Trichodina nigra, Trichodina spp., Tetrahymena corlissi, T. pyriformis, Ichthyophthirius multifiliis, Ichthyobodo necator, Piscinoodinium spp.), 3 species of copepod arthropods (Lernaea cyprinacea, Ergasilus ceylonensis, Argulus foliaceus), 1 metacercarial stage of a digenean trematode (Centrocestus spp.) and 1 nematode (Capillaria spp.) were identified. Parasites were found in fish from 23 of the 26 farms with an overall prevalence of parasitism in 45.3% of fish. The variation in farm prevalence among different parasites was significant (p < 0.01). Fish infection rates with monogenean trematodes, protozoans, copepod crustaceans, digenean trematodes and nematodes were 28.3, 18.4, 4.8, 0.8 and 0.4%, respectively. In all, 50 out of 590 (50/590) guppies were infected with Tetrahymena, compared with 13/930 for all other species, which is a statistically significant result (p < 0.01). Similarly, 13/44 and 18/44 carp were infected with Argulus foliaceus and Lernaea cyprinacea, compared with 7/1476 and 15/1476, respectively, for all other species combined (p < 0.01). Capillaria spp. was found only in guppies (4/590) and angel fish (3/92) while Centrocestus spp. was found in goldfish (12/153) only.