National Dengue Control Unit

2013

Institutional Profile

Ministry of Health , Sri Lanka
Contributors

Dr.Hasitha Tissera
Dr.Nimalka Pannila Hetti
Dr.Nayana De Alwis
Dr. M.P.Pubudu U. Chulasiri


Editors
Dr.B.Deepal W.Jayamanne
Dr.Nayana De Alwis


Cover
Dr.B.Deepal W.Jayamanne








i

Preface
The National Dengue Control Unit (NDCU) was established in 2005 as a decision taken by
the Ministry of Health following a major DF/DHF outbreak occurred in 2004. It is
responsible for the coordination of control and preventive activities related to dengue at
central level between different stakeholders.


Our Vision
To minimize the health, economic and social impact of the disease by reversing the rising
trend of dengue

Our Mission
To enhance the capacity at the national, Provincial, district and divisional levels for
better planning, prediction and early detection and prompt control and
containment of outbreaks and epidemics through partnerships and application of
coordinated efforts in a sustainable manner



ii

Contents
Preface ................................................................................................................................. i
01.Introduction ..................................................................................................................... 1
Technical staff .................................................................................................................. 3
Supportive Staff................................................................................................................ 4
02. Disease Surveillance ..................................................................................................... 6
02. Integrated Vector Management ................................................................................... 10
03. Case Management ...................................................................................................... 15
04 .Intersectoral Coordination & Social mobilization ......................................................... 17
05. Emergency Preparedness: Mitigating outbreaks ......................................................... 19
06. Research ..................................................................................................................... 20



1

01.Introduction

Dengue fever has emerged as the leading public health problem with expanding
geographical boundaries and severity. The mosquito Aedes aegypti and Aedes
albopictus are the two vectors of dengue illness which breed mainly in water
holding containers in domestic and peri-domestic localities.
The National Dengue Control Unit is the focal point for the national dengue control
programme in Ministry of Health, Sri Lanka. It was established in year 2005 as a
decision taken by the Ministry of Health following the major DF/DHF outbreak in
year 2004. It is responsible for the coordination and implementation of dengue
control / prevention activities with different stakeholders.
Former National Coordinators and Directors

Dr.Lakshmi De Silva 2005 - 2008
Dr.Lakmini Magodarathna(Actg) 2008 2009
Dr.Nimalka Pannila Hetti 2009 2011
Dr.R.Batuwantudawe 2011 - 2013
Dr.N. Pannila Hetti (Actg) 2013
Dr.U.Ranasignhe (Actg) 2013
Dr.Hasitha Tissera 2013 to date





2


Organogram of NDCU






Technical Staff
Consultant Community Physicians
Medical Officers
Entomologists
PHHI
Entomology Assistants
Director NDCU
Supportive staff
Development Assistants
Drivers, SKS &
Laborers

3


Technical staff
Director
Dr.Hasitha Tissera
Consultant Community Physicians
Dr.Nimalka Pannila Hetti
Dr.Nayana De Alwis
Medical Officers
Dr.K.A.Sunith D. Kumarapperuma (Biomedical Informatics)
Dr.P.C.Samaraweera
Dr.M.B.Azar Ghouse
Dr.M.P.Pubudu U. Chulasiri
Dr.Iroshini Abeysekara
Dr.B.Deepal W. Jayamanne (Biomedical Informatics)

Entomologists

Ms.M.D.Sakunthala Janaki

Public Health Inspectors
Mr.J.A.D.R. Alwis (SPHI)
Mr.D.M.P.K.Karunarathne
Mr.W.R.A.I.Ranasinghe
Entomological Assistants

Mr.I.D.Hemantha
Ms.G.A.T.A.Rajathilake



4

Supportive Staff

Development Officers/Programme Assistants :

Ms.H.M.D.Herath (Program Assistant)
Ms.P.K.K.Jayarathne (Development Officer)
Ms.U.M.M.Sanathanadevi (Development Officer)
Ms.H.M.P.U.Herath (Development Officer)
Ms.H.D.M.G.Dassanayake (Development Officer)
Ms.M.D.N.Karunarathne (Development Officer)
Ms. J.P.Jasinghe (Development Officer)
Ms.M.D.K.Mahadurage (Development Officer)

Drivers
Mr.W.D.Chandrasena
Mr.S.L.Withanarachchi
Mr.K.A.B.L.Ridmal

SKSS
Ms.D.K.A.Srimathi
Ms.P.K.S.Kumari
Mr.I.A.G.P.Kumara
Mr.P.Darmathilake






5

Profile of the National Dengue Control Unit

Goal: To reduce endemicity to such an extent that it is no longer a major public
health problem in Sri Lanka.
General objective: To reduce morbidity and mortality due to dengue fever (DF)
and dengue haemorrhagic fever (DHF) by 50% of that in 2009, by 2015.
Specific objectives:
To increase the capacity of the health sector to monitor trends and reduce
dengue transmission
To strengthen the capacity to implement effective integrated vector
management.
To increase health workers capacity to diagnose and treat patients and
improve health-seeking behaviour of communities
To promote collaboration among communities, national health agencies and
stakeholders to implement dengue programmes for behavioural change
To increase the capacity to predict, detect early and respond to dengue
outbreaks
To address programmatic issues and gaps that requires new or improved
tools for effective dengue prevention and control


6

02. Disease Surveillance

Epidemiological (disease) surveillance is carried out through the Epidemiology
Unit and data is communicated to National dengue control Unit to monitor
control activities in RDHS and divisional levels. A web based surveillance in
collaboration with the Epidemiology Unit has established in 50 sentinel
hospitals in 2013.It has been further expanded by providing access to MOOH.
In 2013 a total of 31,200 dengue cases were reported from the entire country.
Although the number of cases were high in 2012, the number of deaths were
89 with a case fatality rate of 0.28 which was a marked reduction compared to
previous years (Table 1).

Table 1 : Case Fatality rate from 2009 to 2013
(Source Epidemiology Unit)

Year Dengue Cases Reported Dengue Deaths Case Fatality Rate
2009 35,095 346 0.98
2010 34,105 246 0.72
2011 28,473 184 0.65
2012 44,456 181 0.41
2013 31,975 89 0.28

7


Reported incidence by districts - 2013

Figure 1



Two distinct peaks of case reporting in May July and Oct Jan are identified
over the years associated with South-West and North-East monsoon rains
respectively. Therefore it is evident that preventive activities should be initiated
before the increase of cases as such, bi-annual mosquito control weeks are
conducted in April and September.


8


Sentinel Site Surveillance

Figure 2

Establishment of web based system to enhance disease surveillance in
collaboration with the Epidemiology Unit in 50 sentinel hospitals. In 2013 DGH
Matale, BH Kuliyapitiya, BH Dambadeniya, BH Wathupitiwala, BH Marawila , BH
Karawanalla, BH Kamburupitiya .


9

High Risk Districts 2013 - Based on notified cases

Figure 3




10

02. Integrated Vector Management

Entomological surveillance
Entomological surveillance is carried out under the purview of the National Dengue
Control Unit, Anti Malaria Campaign, Anti Filariasis Campaign and Medical
Research Institute through their counterparts at regional level.
Districts under purview of different campaigns

Figure 4


11

Summary of Entomological surveys 2013 Premises and found positive

Figure 5

Vector surveillance is important to forecast possible outbreaks and initiate early
measures to prevent the occurrence of outbreaks and to limit the spread. Vector
indices are calculated (Breteau Index-BI, Premise index-PI and Container Index-
CI) for assessment of risk and impact of control activities.
In 2013 a total of 185,090 premises were inspected, where Aedes larvae were
found positive in 15,860(8.6%) containers. The types of examined containers are
illustrated below (Figure 6).


15505
15174
13477
11398
14167
16818
14210
15936
15215
14865
13388
15425
1051
773 761 650
1032 946
676 788 680
735 1098
1179
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
Premises Inspected Premises Positive

12

Summary of Entomological surveys 2013 % positive of the type of Containers

Figure 6
Vector Control
Vector control interventions including source reduction (Elimination of breeding
places), biological and chemical vector control activities are carried out by the
health authorities with all relevant stakeholders and the community in accordance
with the guidelines of the Ministry of Health . Vector control activities are carried
out on a high risk approach based on epidemiological and entomological
parameters.
Vector Control activities are conducted through the field health staff attached to
the Medical Officer of Health offices in the country in collaboration with the
Regional Malaria officers (RMO) Medical officer AFC, entomologists and their
teams at district level
Discarded
Receptacles
47%
Water
storage
containers
15%
Miscellaneou
s
9%
Cement
Tanks
7%
Tyres
7%
Natural
6%
A/C,
Refrigerators
3%
Gutters
2%
Ornamentals
2%
Wells
1%
Concrete slab
1%
Ponds
0%
Other
4%

13

Major Activities in 2013
Facilitating district and divisional level vector management staff to perform
optimally to control dengue vectors by providing training, equipment,
chemicals, technical guidance and other resources
o 09 Vehicle Mount Fogging machines were distributed away high risk
districts. (Colombo AFU, Gampaha, Kalutara, Galle , Matara,
Kegalle,Rathnapura,Kurunegala,Puttalam )
o 100 Hand held Fogging machines were distributed (based on
requirement among all RDHS divisions) (Table 02)
o 496 sets of Personal protective equipment were distributed to vector
control personnel which included pair of boots, Goggles ,Gloves, Ear
Plugs, Respirators and Helmets
Insecticide resistance monitoring
Development of training manuals and guidelines on vector surveillance and
control
Monitoring & Evaluation of district level activities
Conduct of monthly Review meetings
Reviewing weekly entomology returns and sending alerts whenever
entomology indices are high
Distribution of Fogging Machines 2013
Province District Unit Distributed
Western

Colombo AF Unit 3
Kalutara
DGH Kalutara 1
RDHS Kaluara 5
Colombo
Rapid Deployment Force 5
NDCU Entomology Team 5
Gampaha RDHS Gampaha 5
Kalutara NIHS Kalutara 2
Uva
Badulla RDHS Badulla 3
Monaragala RDHS Monaragala 3


14

Southern
Galle RDHS Galle 5
Matara RDHS Matara 5
Hambantota RDHS Hambantota 3
Sabaragamuwa
Kegalle RDHS Kegalle 4
Rathnapura RDHS Ratnapura 6
Nothern
Killinochchi RDHS Killinochchi 1
Mullativu RDHS Mullaitivu 1
Vavuniya RDHS Vavuniya 2
Jaffna RDHS Jaffna 3
Mannar RDHS Mannar 3
North Western
Kurunagala RDHS Kurunegala 4
Puttlum RDHS Puttalam 4
North Central
Anuradhapura RDHS Anuradhapura 3
Polonnaruwa RDHS Polonnaruwa 4
Eastern
Ampara RDHS Amapara 3
Kalmunai RDHS Kalmunai 1
Batticoloa RDHS Batticaloa 3
Trincomalee RDHS Trincomalee 3
Central
Nuwara Eliya RDHS Nuwara Eliya 2
Matale RDHS Matale 3
Kandy RDHS Kandy 5
Total 100
Table 2


15

03. Case Management
During 2013, curative health care personal were trained on proper management of
dengue patients based on National guidelines coordinated by the Epidemiology
Unit and Education, Training & Research unit, Ministry of Health.
Management of dengue cases was further enhanced by establishing 24 new High
Dependency Units (HDU) in selected hospitals. In addition equipments for existing
HDUs were also provided during 2013.
Table 2: HD Units of Health Institutions provided with equipments in 2013
Type of Hospital No. of HDUs facilitated in 2013
Teaching Hospitals 06
Provincial General Hospitals 03
District General Hospitals 07
A Grade Base Hospitals 05
B Grade Base Hospitals 14
Total 35
Table 3

All HDUs Established New HDU establishments In 2013


Figure 7



16

Distribution of Microhaematocrit centrifuges for Hospitals:
157 devices distributed up to 2013 among 68 institutions and 21 devices
distributed to selected hospitals among 11 districts. (Table 4)
Province District Hospital
Distributed
Western
Colombo
Lady Ridgeway Hospital for Children
3
NHSL
4
Kalurata
RDHS Kalutara
1
Uva Badulla
PGH Badulla
2
UP Monaragala
BH Embilipitiya
2
Southern Galle
BH Elpitiya
1
Northern Jaffna
TH Jaffna
1
North Western Kurunagala
PGH Kurunegala
4
EP Ampara
BH Sammanthurai
1
Central Kandy
TH Peradeniya
1
BH Gampola
1
Total 21
Table 4
Provision of Portable ultra sound scanners for selected hospitals.
Distributed 10 colour Doppler portable US scan machines among Major Hospitals
for the first time (Table 5) (NHSL, Teaching Hospitals-06, Provincial General
Hospitals -02, Base Hospitals-01)
Province District Hospital
Western
Colombo TH Kalubowila
Gampaha TH Ragama
Colombo BH Angoda (IDH)
Colombo NHSL
Southern Galle TH Karapitiya
Sabaragamuwa Rathnapura PGH Ratnapura
Northern Jaffna TH Jaffna
North Western Kurunagala PGH Kurunegala
North Central Anuradhapura TH Anuradhapura
Central Kandy TH Kandy

17

04 .Intersectoral Coordination & Social mobilization

The Presidential Task Force was appointed by H.E. the President to strengthen
mulitisectoral collaboration and implementation of strategies at the
National/Provincial/District levels. The first meeting was convened on 25. 05.2010
chaired by H.E. the President.
Members of the Task Force

Ministry of Health

Ministry of Public Administration

Ministry of Education

Ministry of Environment

Ministry of Local Government

Ministry of Media

Ministry of Disaster Management

Ministry of Defence & Ministry of Law & Order

Major activities carried out in 2013
Declaration of Mosquito Prevention Weeks and media seminars
o 1
st
from 06
th
to 12 February
o 2
nd
from 01
st
to 06
th
July
o 3
rd
from 07
th
to 13
th
October

Production of IEC materials
Advertising campaigns through electronic and print media to create
awareness of public on control / prevention strategies and to promote
health seeking behaviour
Teacher Training programmmes Kaduwela, Kalutara, Kandy, Galle


18

Participation for the exhibitions
1.Deyata Kirula 2013
2. Other Places (10)
1. Aluthwela Maha Vidyalaya
2. Private Institution (Bodyline),Horana
3. Urubokka National School
4. Zahira College, Gampola
5. MC Nawalapitiya
6. Vesak Zone ,Dehiwala
7. International School,Kohuwala (Colombo South)
8. Bamunugama Central College, Mulatiyana
9. International School,Moratuwa (Asian)
10. Rivisanda Maha Vidyalaya, Aranayaka







19

05. Emergency Preparedness: Mitigating outbreaks

Harnessing activities at district & divisional level

Emergency response includes measures to reduce the number of infective
mosquitoes rapidly and proper management of patients

Based on notification,
Early detection of increasing fever cases at treatment facilities
Analyze data by district/ MOH areas/smaller localities
Anticipating/predicting outbreaks using surveillance data
Use of entomological surveillance data timely to forecast / Identify high risk
areas
Develop plans for vector control
Set targets
Identify strategies/ resources
Monitoring & evaluation


20

06. Research

One of the major research activities done by the National dengue Control unit is
conducting a research on Effectiveness of using Bacillus thuringiensis israelensis
briquette formulation (Mosquito dunk) in Dengue control and Prevention activities
in selected MOH areas in the Western Province Sri Lanka.
An interventional study with pre and post intervention (Application of Bti dunks)
observations and with control to the experiment was done in selected MOH aeras
in Colombo and Gamaha RDHS areas. Vector densities and incidence of dengue
cases were compared as outcome variables before and after the intervention
within the individual intervention areas and in comparison to selected control
areas.
Majority (>60%) of potential and positive breeding places were removable and
there were no places for application of mosquito dunks in all study areas. Places
where mosquito dunks can be applied remained few in number throughout and
there was no considerable difference in container index or Breteau index even
after application of Bti dunks in comparison to the same in controled areas. Of the
households that have received the dunks, majority have applied them into roof
gutters drains or gullies.
The cost of application of mosquito dunk through health system is enormous.