Molecular epidemiology of rotaviruses in the south-east Asian region from 2009 to 2015.

BACKGROUND: In Asia, rotavirus accounts for approximately 45% of admissions due to acute gastroenteritis in children <5 years, and causes about 145,000 deaths every year. We studied the distribution of rotavirus strains from Myanmar, Sri Lanka, and Nepal during 2009-2015. METHODS: Stool samples collected from children <5 years of age hospitalized with acute diarrhea in the three sites and positive for rotavirus antigen by enzyme immunoassay (EIA) were sent to the Christian Medical College, Vellore from 2009 to 2015. G and P typing of rotavirus strains were performed using reverse-transcription polymerase chain reaction (RT-PCR). RESULT: Of the 2354 EIA positive samples tested, G12P[8] (36.8%), G1P[8] (30.1%), and G12P[6] (41.3%) were the most common strains isolated from Myanmar, Sri Lanka, and Nepal respectively. CONCLUSION: There was substantial diversity of rotavirus genotypes, and continued surveillance in developing countries of Asia will help in understanding the epidemiology of rotavirus before and after introduction of vaccines.

Sri Lanka takes action towards a target of zero rabies death by 2020.

Rabies is a 100% vaccine-preventable and 100% fatal zoonotic, viral disease. It is usually spread to humans by saliva, through bites or scratches. Dogs are the source of the vast majority of human deaths from rabies. Political will and leadership have been the main drivers for success of the Sri Lankan effort to reduce the burden of disease attributable to rabies. Post-exposure prophylaxis, which is available in government health facilities, at no cost, to all bite patients, has been a main axis of the rabies-elimination strategy. To attain the last mile in rabies elimination in Sri Lanka by 2020, more will need to be done to scale up dog vaccination, enforce responsible dog ownership, strengthen surveillance for animals and humans and conduct mass awareness programmes. Sri Lanka is the first country in the World Health Organization South-East Asia Region to develop a national strategy for elimination of dog-mediated rabies and is a key country in sharing knowledge, expertise and capacity-building in the region, towards a global target of zero rabies deaths by 2030.

Malaria elimination in Sri Lanka: what it would take to reach the goal.

Fifty years after narrowly missing the opportunity to eliminate malaria from Sri Lanka in the 1960s, the country has now interrupted malaria transmission and sustained this interruption for more than 12 months - no indigenous malaria cases have been reported since October 2012. This was achieved through a period overlapping with a 30-year separatist war in areas that were endemic for malaria. The challenge now, of sustaining a malaria-free country and preventing the reintroduction of malaria to Sri Lanka, is examined here in the context of rapid postwar developments in the country. Increased travel to and from the country to expand development projects, businesses and a booming tourist industry, and the influx of labour and refugees from neighbouring malarious countries combine with the continued presence of malaria vectors in formerly endemic areas, to make the country both receptive and vulnerable to the reintroduction of malaria. The absence of indigenous malaria has led to a loss of awareness among the medical profession, resulting in delayed diagnosis of malaria despite the availability of an extensive malaria diagnosis service. Highly prevalent vector-borne diseases such as dengue are competing for health-service resources. Interventions that are necessary at this critical time include sustaining a state-of-the-art surveillance and response system for malaria, and advocacy to maintain awareness among the medical profession and at high levels of government, sustained funding for the Anti-Malaria Campaign and for implementation research and technical guidance on elimination. The malaria-elimination effort should be supported by rigorous analyses to demonstrate the clear economic and health benefits of eliminating malaria, which exceed the cost of a surveillance and response system. An annual World Health Organization review of the programme may also be required.

Analysis of hospital-based sentinel surveillance data on leptospirosis in Sri Lanka, 2005-2008.

In Sri Lanka, leptospirosis is a notifiable disease. In addition to having a routine disease reporting system, Sri Lanka has implemented a hospital-based sentinel surveillance system since 2004. This report discusses the findings of a descriptive analysis of the sentinel surveillance data collected from 2005 to 2008. Of the 4,000 suspected leptospirosis cases, 46.9% and 26.8% were recorded from the Western and Sabaragamuwa provinces, respectively. Most of the individuals were male (83.5%), and approximately 45.6% were aged 30-49 years. Farmers accounted for 16.5%, and laborers for 16.1%; however, the occupation of nearly half (44.8%) of the study population was unknown. More than half (53.9%) of the individuals worked in paddy fields. Almost all had acute fever (98.8%), myalgia (92.9%), and headache (92.7%), but fewer had other related symptoms. Out of the 4,000 individuals, 2,496 (62.4%) underwent a laboratory test; however, the laboratory test results of only 1,445 (57.9%) and the microscopic agglutination results of 41 (2.8%) were available at the sentinel sites. Less than 2% of the reported individuals underwent prophylactic treatment. These findings will help enhance the ongoing efforts for controlling and preventing leptospirosis in Sri Lanka. Sentinel surveillance is a useful tool, but the data quality needs to be improved by supplementing the findings with adequate laboratory diagnosis data.

Factors contributing to medication noncompliance of newly diagnosed smear-positive pulmonary tuberculosis patients in the district of Colombo, Sri Lanka.

Medication noncompliance hinders effective tuberculosis control. This descriptive study investigates the factors contributing to medication noncompliance among new patients with smear-positive pulmonary tuberculosis on treatment at government health institutions in Colombo, Sri Lanka. In a cohort of patients aged > or =15 years (n = 326), 23% were found to be noncompliers (n = 74) on follow-up. The median age of noncompliers (50 years) was significantly higher than the compliers (45 years). In multivariate logistic regression analysis, factors associated with noncompliance are as follows: being a male, living alone or with extended family, experiencing side effects to medication, perceiving nonsusceptibility to adverse effects of illness, and perceiving no benefit in regular treatment. The participants of a focus group discussion on service factors opined that the reception at treatment facilities and the interaction with certain categories of staff were poor. Noncompliance is related to a multiplicity of factors involving patients and healthcare services.