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)
2000 No of Typhoid Fever cases Typhoid Fever Incidence in Sri Lanka 1800 1868 1771 1600 1612 1400 1200 1242 1340 1296 1128 1000 987 800 843 736 600 400 200 Outbreak of Typhoid in IDP camps due to civil unrest in the country 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Typhoid Fever Incidence and Incidence Rate in Sri Lanka 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 Outbreak of Typhoid in IDP camps due to civil unrest in the country
< 2Y 2-5Y 5Y-10Y 10-15Y 15-20Y 20-25Y 25-30Y 30-35Y 35-40Y 40-45Y 45-50Y 50-55Y 55-60Y 60-120 18 Age Specific Incidence Rate 16 Age Specific Typhoid Fever Incidence Rates in Sri Lanka 2010-2014 14 12 10 8 6 4 Incidence Rate per 100,000 Highest Incidence in10-15y age group (15.6%) 83% of cases in 5-50Y age group 2 0 Age Category
Jaffna Colombo Vavuniya Nuwara-Eli Badulla Ratnapura Puttalam Kurunegala Mannar Kalutara(N Gampaha Kandy Kegalle Monaragala Matara Matale Batticaloa Kalmunai Polonnaruwa Trincomale Anuradhapu Mullativu Galle Kilinochch Hambantota Ampara 262 238 196 162 157 146 133 125 122 114 99 58 671 646 561 550 518 509 467 427 408 386 1028 1010 1242 2588 Typhoid Fever Incidence in Sri Lanka by District, 2005-2014 0 500 1000 1500 2000 2500 3000
Jaffna Colombo Kalutara(N Gampaha Vavuniya Kegalle Kandy Mannar Ratnapura Kurunegala Kilinochch Batticaloa Matale Matara Nuwara-Eli Monaragala Badulla Puttalam Mullativu Polonnaruwa Ampara Hambantota Trincomale Galle Anuradhapu 77 75 73 63 61 60 50 44 41 34 32 30 28 27 23 23 19 19 17 12 12 6 109 195 Typhoid Fever Incidence in Sri Lanka by District, 2013-2014 449 0 50 100 150 200 250 300 350 400 450 500
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
1400 Typhoid Incidence 1200 Typhoid Fever incidence VS Vaccination 160000 No of Vaccines given 140000 1000 Typhoid Incidence No of Vaccines 120000 800 100000 80000 600 60000 400 40000 200 20000 0 2010 2011 2012 2013 2014 0
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 Total No of Water samples-3396 47.08480565 Satisfactory 52.91519435 Unsatisfactory
Water Quality-2012 Source No of samples tested Satisfactory (%) NWS&DB 558 431 (77.2) 127(22.8) Unsatisfactory(%) 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 Total No of Water samples-4391 49.60145753 Satisfactory 50.39854247 Unsatisfactory
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
Percentage of satisfactory samples 100.00% Analysis of Water Samples -2014 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% This may be a biased samples-most of the water samples were collected from Water sources which were suspected of being contaminated
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