2017 dengue outbreak in Sri Lanka
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2017 dengue outbreak in Sri Lanka | |
---|---|
Disease | Dengue fever |
Virus strain | Dengue virus |
First outbreak | Sri Lanka |
Dates | May 2017 – Aug 2017 |
Type | DENV-2 |
Confirmed cases | 186,101 |
Deaths | 440 |
Fatality rate | 0.24% |
Vaccinations | no vaccine available (at time) |
In 2017, a rise in the number of dengue fever cases was reported on the island country of Sri Lanka. The peak of the outbreak was in the mid-year monsoon season, where more than 40,000 cases in July marked a record far exceeding historical highs. Year-end total dengue cases rose to 186,101.
Most cases (43%) were recorded in Western Province urban areas such as the Colombo district.[1] Most dengue cases were found in young people and school children. By the end of the year, the total number of dengue-related deaths was 440.
Background[edit]
In 2017 Sri Lanka experienced its largest neglected tropical disease outbreak of dengue fever since the first recorded Sri Lankan case in 1962.[2][3][4] This biological hazard, transmitted via female mosquito bites, caused 186,101 dengue cases, significantly higher than in previous years (table 2), and 440 deaths.[5][6][7]
Year | Number of cases |
---|---|
2010 | 34,188 |
2011 | 28,473 |
2012 | 44,461 |
2013 | 32,063 |
2014 | 47,502 |
2015 | 29,777 |
2016 | 50,592 |
2017 | 186,101 |
2018 | 51,659 |
2019 | 105,049 |
2020 | 31,162 |
2021 | 25,067 |
2022 | 57,864 |
Outbreak[edit]
Sri Lanka's Ministry of Health (MoH) reported a rise in cases from January, with the highest number of cases reported in July.[8] Most cases were recorded in the west and north of the country, specifically in the urban Colombo district.[5]
Area | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | Total |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Sri Lanka | 10,927 | 8,724 | 13,540 | 12,540 | 15,963 | 25,319 | 41,121 | 22,270 | 9,519 | 6,614 | 8,868 | 10,753 | 186,158 |
Colombo District | 2,734 | 1,900 | 2,467 | 2,570 | 3,333 | 5,372 | 7,471 | 3,620 | 1,251 | 823 | 1,131 | 1,602 | 34,274 |
Gampaha District | 1,635 | 1,087 | 1,870 | 2,072 | 3,168 | 4,901 | 9,039 | 3,553 | 1,246 | 779 | 1,078 | 1,219 | 31,647 |
Kalutara District | 581 | 448 | 836 | 739 | 946 | 1,248 | 2,612 | 1,477 | 663 | 337 | 528 | 546 | 10,961 |
The Government of Sri Lanka spent more than US$12 million on outbreak control and was supported by NGOs such as the Red Cross.[10][5][11]
Causes[edit]
Climate[edit]
- Sri Lanka's tropical climate offers prime mosquito breeding conditions.[12]
- The 2017 monsoon rains (May–August) coincided with the peak of the dengue outbreak (table 2). Triggering floods and disrupting refuse collection, increasing mosquito breeding sites.[4][13]
- However, annual rainfall and El Nino conditions were lower on average than previous years, suggesting that climate was not completely responsible for the outbreak.[5]
Political[edit]
- MoH failed to prepare and take appropriate mosquito vector control.[3][14]
- Insufficiencies in the virologic surveillance program failed to identify dengue serotypes and genotypes.[3][4][15] Leaving Sri Lanka unprepared for new strains (DENV-2), for which their population would have little immunity.[1][5][15]
Socio-economic[edit]
- Sri Lanka is a middle-income country with a GDP per capita of US $12,600 (2017).[16] This restricts investment in healthcare infrastructure resulting in an overstretched healthcare system.[4]
- High urban population density in western districts created higher probability of transmission.[5]
- In 2017, 42% of Sri Lankans were in extreme poverty (below US$5.50 a day) which limits a family's access to healthcare and increases risk of disease.[16][17]
- Regional disparities, due to the Sri Lankan civil conflict (1983-2009), displaced people to IDP camps and marginalized ethnic groups (Tamils) in north and eastern districts, reducing support and increasing disease risk.[18][19]
Impacts[edit]
Short-term impacts[edit]
- Unexpected high death toll.[4]
- Disruption to workplaces, household income, and education as the majority of cases were of people aged 10–29.[5]
- Direct and indirect impacts of the dengue outbreak affected 600,000 people, in all 25 districts, prominently in urban areas.[1] However, some districts may have been under-reported due to ethnic marginalization and the presence of IDP camps.[18][20]
- Dengue treatment strained national economic resources costing Sri Lanka US $12.7 million (LKR 1.938 billion).[5]
Long-term impacts[edit]
- Today dengue cases are declining in Sri Lanka, with 25,067 total cases in 2021 (table 1).[8]
- Dengue is still present with new strains (serotypes DENV-3 and DENV-4) becoming more prominent threatening future outbreaks.[15]
- Combined with the COVID-19 pandemic there is still immense pressures on healthcare and trade networks.[21]
- 2022 has seen an economic crisis and severe food insecurity in Sri Lanka, the dengue outbreak would be a contributing factor.[22][23]
Future[edit]
Climate change models suggest that Sri Lanka's climate is becoming more conducive to mosquito breeding, this combined with economic instability could trigger a future epidemic.[23][24] There is a possibility of a cycle of disease, poverty and food insecurity which may be challenging to break.[25] However, this could be mitigated if the MoH, supported by institutions like WHO, engage in proactive strategies.[21] A licensed vaccine (Dengvaxia) is now available, at the cost of US$78 per person - with five more in development.[21] However, Sri Lanka's current expenditure is US$161 per capita on healthcare (2021), the vaccine is a significant proportion of that budget and in uncertain economic times may not be a priority.[26][27]
See also[edit]
External links[edit]
References[edit]
- ^ a b c "WHO | Dengue fever – Sri Lanka". WHO. Archived from the original on July 21, 2017. Retrieved 2020-11-27.
- ^ "CDC - Neglected Tropical Diseases - Diseases". www.cdc.gov. 2022-03-07. Retrieved 2022-10-28.
- ^ a b c Ngwe Tun, Mya Myat; Muthugala, Rohitha; Nabeshima, Takeshi; Rajamanthri, Lakmali; Jayawardana, Dulani; Attanayake, Shanthi; Soe, Aung Min; Dumre, Shyam Prakash; Ando, Tsuyoshi; Hayasaka, Daisuke; Inoue, Shingo; Buerano, Corazon C.; Morita, Kouichi (2020-04-01). "Unusual, neurological and severe dengue manifestations during the outbreak in Sri Lanka, 2017". Journal of Clinical Virology. 125: 104304. doi:10.1016/j.jcv.2020.104304. ISSN 1386-6532. PMID 32145478. S2CID 212629415.
- ^ a b c d e Ali, Shahid; Khan, Abdul Waheed; Taylor-Robinson, Andrew W.; Adnan, Muhammad; Malik, Shahana; Gul, Saba (June 2018). "The unprecedented magnitude of the 2017 dengue outbreak in Sri Lanka provides lessons for future mosquito-borne infection control and prevention". Infection, Disease & Health. 23 (2): 114–120. doi:10.1016/j.idh.2018.02.004. PMID 38715304. S2CID 80605119.
- ^ a b c d e f g h Tissera, Hasitha A.; Jayamanne, Bernard D.W.; Raut, Rajendra; Janaki, Sakunthala M.D.; Tozan, Yesim; Samaraweera, Preshila C.; Liyanage, Prasad; Ghouse, Azhar; Rodrigo, Chaturaka; de Silva, Aravinda M.; Fernando, Sumadhya D. (April 2020). "Severe Dengue Epidemic, Sri Lanka, 2017". Emerging Infectious Diseases. 26 (4): 682–691. doi:10.3201/eid2604.190435. ISSN 1080-6040. PMC 7101108. PMID 32186490.
- ^ "What is a disaster? | IFRC". www.ifrc.org. Retrieved 2022-10-28.
- ^ Stanaway, Jeffrey D; Shepard, Donald S; Undurraga, Eduardo A; Halasa, Yara A; Coffeng, Luc E; Brady, Oliver J; Hay, Simon I; Bedi, Neeraj; Bensenor, Isabela M; Castañeda-Orjuela, Carlos A; Chuang, Ting-Wu; Gibney, Katherine B; Memish, Ziad A; Rafay, Anwar; Ukwaja, Kingsley N (June 2016). "The global burden of dengue: an analysis from the Global Burden of Disease Study 2013". The Lancet Infectious Diseases. 16 (6): 712–723. doi:10.1016/S1473-3099(16)00026-8. PMC 5012511. PMID 26874619.
- ^ a b c d "Trends". www.epid.gov.lk. Archived from the original on 2022-12-09. Retrieved 2022-10-28.
- ^ "Trends". www.epid.gov.lk. Retrieved 2020-11-27.
- ^ "Sri Lanka: Dengue Outbreak - Jul 2017". ReliefWeb. 21 August 2018. Retrieved 2020-11-27.
- ^ "Dengue Fever Outbreak in Sri Lanka Kills Nearly 300 People". Time. Retrieved 2020-11-27.
- ^ "Dengue and severe dengue". www.who.int. Retrieved 2022-10-28.
- ^ Guha-Sapir, Debarati; van Panhuis, Willem Gijsbert (December 2009). "Health Impact of the 2004 Andaman Nicobar Earthquake and Tsunami in Indonesia". Prehospital and Disaster Medicine. 24 (6): 493–499. doi:10.1017/S1049023X00007391. ISSN 1049-023X. PMID 20301065. S2CID 14765887.
- ^ Tissera, H. A.; Samaraweera, P. C.; Jayamanne, B. D. W.; Janaki, M. D. S.; U Chulasiri, M. P. P.; Rodrigo, C.; Fernando, S. D. (February 2018). "Use of Bacillus thuringiensis israelensis in integrated vector control of Aedes sp. in Sri Lanka: a prospective controlled effectiveness study". Tropical Medicine & International Health. 23 (2): 229–235. doi:10.1111/tmi.13015. hdl:1959.4/unsworks_48835. PMID 29164802. S2CID 5071742.
- ^ a b c Ngwe Tun, Mya Myat; Muthugala, Rohitha; Rajamanthri, Lakmali; Nabeshima, Takeshi; Buerano, Corazon C.; Morita, Kouichi (2021-09-30). "Emergence of Genotype I of Dengue Virus Serotype 3 during a Severe Dengue Epidemic in Sri Lanka in 2017". Japanese Journal of Infectious Diseases. 74 (5): 443–449. doi:10.7883/yoken.JJID.2020.854. ISSN 1344-6304. PMID 33642435. S2CID 232078010.
- ^ a b "Gapminder Tools". www.gapminder.org. Retrieved 2022-10-28.
- ^ WHO (2017). "World Bank and WHO: Half the world lacks access to essential health services, 100 million still pushed into extreme poverty because of health expenses". www.who.int. Retrieved 2022-10-28.
- ^ a b "Sri Lanka - World Directory of Minorities & Indigenous Peoples". Minority Rights Group. 2019-06-19. Retrieved 2022-10-28.
- ^ Kapila, Mukesh (2018). "Healthcare in Conflict Settings". World Innovation Summit for Health. Retrieved 2022-10-28.
- ^ Xiao-Nong Zhou; Robert Bergquist; Remigio Olveda; Jürg Utzinger, eds. (2010). Advances in Parasitology: Important Helminth Infections in Southeast Asia: Diversity and Potential for Control and Elimination. Part A. London. ISBN 978-0-12-381956-7. OCLC 689053662.
{{cite book}}
: CS1 maint: location missing publisher (link) - ^ a b c WHO (2022). "Vaccines and immunization: Dengue". www.who.int. Retrieved 2022-10-28.
- ^ Root & Win (2022-08-09). "How Sri Lanka went from topping Lonely Planet's list to almost 30% hunger levels". The New Humanitarian. Retrieved 2022-10-28.
- ^ a b Quiggin, John; Mallawaarachchi, Thilak (25 July 2022). "How did Sri Lanka run out of money? 5 graphs that explain its economic crisis". The Conversation. Retrieved 2022-10-28.
- ^ Bhatia, Surbhi; Bansal, Dhruvisha; Patil, Seema; Pandya, Sharnil; Ilyas, Qazi Mudassar; Imran, Sajida (2022). "A Retrospective Study of Climate Change Affecting Dengue: Evidences, Challenges and Future Directions". Frontiers in Public Health. 10: 884645. doi:10.3389/fpubh.2022.884645. ISSN 2296-2565. PMC 9197220. PMID 35712272.
- ^ Yngve, Agneta; Margetts, Barrie; Hughes, Roger; Tseng, Marilyn (November 2009). "Food insecurity – not just about rural communities in Africa and Asia". Public Health Nutrition. 12 (11): 1971–1972. doi:10.1017/S1368980009991650. ISSN 1475-2727. PMID 19814853.
- ^ "Current health expenditure (% of GDP) - Sri Lanka | Data". data.worldbank.org. Retrieved 2022-10-28.
- ^ Pearson, Carl A. B.; Abbas, Kaja M.; Clifford, Samuel; Flasche, Stefan; Hladish, Thomas J. (August 2019). "Serostatus testing and dengue vaccine cost–benefit thresholds". Journal of the Royal Society Interface. 16 (157): 20190234. doi:10.1098/rsif.2019.0234. ISSN 1742-5689. PMC 6731500. PMID 31431184.