typhoid vaccination situation in sri lanka...2015/05/08 · epidemiology of typhoid fever in sri...
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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)
1868
1612
1242
1340
1771
1296
1128
987
843
736
0
200
400
600
800
1000
1200
1400
1600
1800
2000
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Typhoid Fever Incidence in Sri Lanka No of Typhoid
Fever cases
Outbreak of Typhoid in IDP camps due to civil unrest in the country
Year Incidence Incidence Rate (per
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
Typhoid Fever Incidence and Incidence Rate in Sri Lanka
Outbreak of Typhoid in IDP camps due to civil unrest in the country
0
2
4
6
8
10
12
14
16
18
< 2
Y
2 -
5Y
5Y
-10Y
10-1
5Y
15-2
0Y
20-2
5Y
25-3
0Y
30-3
5Y
35-4
0Y
40-4
5Y
45-5
0Y
50-5
5Y
55-6
0Y
60-1
20
Incidence Rate per 100,000
Age Specific Typhoid Fever Incidence Rates in Sri Lanka
2010-2014
Age Specific
Incidence Rate
Age Category
Highest Incidence
in10-15Y age
group –(15.6%)
83% of cases
in 5-50Y age
group
58
99
114
122
125
133
146
157
162
196
238
262
386
408
427
467
509
518
550
561
646
671
1010
1028
1242
2588
0 500 1000 1500 2000 2500 3000
Ampara
Hambantota
Kilinochch
Galle
Mullativu
Anuradhapu
Trincomale
Polonnaruwa
Kalmunai
Batticaloa
Matale
Matara
Monaragala
Kegalle
Kandy
Gampaha
Kalutara(N
Mannar
Kurunegala
Puttalam
Ratnapura
Badulla
Nuwara-Eli
Vavuniya
Colombo
Jaffna
Typhoid Fever Incidence in Sri
Lanka
by District, 2005-2014
6
12
12
17
19
19
23
23
27
28
30
32
34
41
44
50
60
61
63
73
75
77
109
195
449
0 50 100 150 200 250 300 350 400 450 500
Anuradhapu
Galle
Trincomale
Hambantota
Ampara
Polonnaruwa
Mullativu
Puttalam
Badulla
Monaragala
Nuwara-Eli
Matara
Matale
Batticaloa
Kilinochch
Kurunegala
Ratnapura
Mannar
Kandy
Kegalle
Vavuniya
Gampaha
Kalutara(N
Colombo
Jaffna
Typhoid Fever Incidence in Sri Lanka
by District, 2013-2014
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
0
20000
40000
60000
80000
100000
120000
140000
160000
0
200
400
600
800
1000
1200
1400
2010 2011 2012 2013 2014
Typhoid Incidence
No of Vaccines
Typhoid Incidence Typhoid Fever incidence VS
Vaccination No of Vaccines given
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
from an MOH area
per month
NRL
Water Quality-2012
47.08480565
52.91519435
Satisfactory
Unsatisfactory
Total No of Water samples-3396
Water Quality-2012…
Source No of samples
tested
Satisfactory (%) Unsatisfactory(%)
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
50.39854247
49.60145753 Satisfactory
Unsatisfactory
Total No of Water samples-4391
Water Quality-2013…
Source No of samples
tested
Satisfactory (%) Unsatisfactory(%)
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
tested
Satisfactory (%) Unsatisfactory(%)
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
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
Analysis of Water Samples -2014
This may be a biased samples-Most of the water samples were collected from
Water sources which were suspected of being contaminated
Percentage of
satisfactory
samples
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