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2017 dengue outbreak in Sri Lanka

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2017 dengue outbreak in Sri Lanka
DiseaseDengue fever
Virus strainDengue virus
First outbreakSri Lanka
DatesMay 2017 – Aug 2017
Type
DENV-2
Confirmed cases186,101
Deaths
440
Fatality rate0.24%
Vaccinationsno vaccine available (at time)

In 2017, there was a rise in the number of dengue fever cases reported in the island country of Sri Lanka. The peak of the outbreak occurred during the mid-year monsoon season, with more than 40,000 cases reported in July alone, far exceeding historical highs. By the end of the year, the total number of dengue cases had risen to 186,101.[1]

Most cases (43%) were recorded in urban areas of the Western Province, such as the Colombo district.[2] The majority of dengue cases affected young people and school children. By the end of the year, the total number of dengue-related deaths reached 440.

Background

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In 2017, Sri Lanka experienced its largest outbreak of dengue fever, a neglected tropical disease, since the first recorded case in 1962.[3][4][5] This biological hazard, transmitted via female mosquito bites, resulted in 186,101 dengue cases, a significant increase compared to previous years (see table 2), and let to 440 deaths.[6][7][8]

Annual dengue cases, 2010–2022[9]
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

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Sri Lanka's Ministry of Health (MoH) reported an increase in dengue fever cases from January, peaking in July.[9] The Majority of cases were concentrated in the western and northern parts of the country, particularly in the urban Colombo district.[6]

Reported dengue cases (2017)[10][9]
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 over US$12 million on outbreak control efforts, with support from NGOs like the Red Cross.[11][6][12]

Causes

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Climate

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  • Sri Lanka's tropical climate offers prime mosquito breeding conditions.[13]
  • 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.[5][14]
  • However, annual rainfall and El Nino conditions were lower on average than previous years, suggesting that climate was not completely responsible for the outbreak.[6]

Political

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Socio-economic

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Impacts

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Short-term impacts

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  • Unexpected high death toll.[5]
  • Disruption to workplaces, household income, and education as the majority of cases were of people aged 10–29.[6]
  • Direct and indirect impacts of the dengue outbreak affected 600,000 people, in all 25 districts, prominently in urban areas.[2] However, some districts may have been under-reported due to ethnic marginalization and the presence of IDP camps.[19][21]
  • Dengue treatment strained national economic resources costing Sri Lanka US $12.7 million (LKR 1.938 billion).[6]

Long-term impacts

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  • Today dengue cases are declining in Sri Lanka, with 25,067 total cases in 2021 (table 1).[9]
  • Dengue is still present with new strains (serotypes DENV-3 and DENV-4) becoming more prominent threatening future outbreaks.[16]
  • Combined with the COVID-19 pandemic there is still immense pressures on healthcare and trade networks.[22]
  • 2022 has seen an economic crisis and severe food insecurity in Sri Lanka, the dengue outbreak would be a contributing factor.[23][24]

Future

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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.[24][25] There is a possibility of a cycle of disease, poverty and food insecurity which may be challenging to break.[26] However, this could be mitigated if the MoH, supported by institutions like WHO, engage in proactive strategies.[22] A licensed vaccine (Dengvaxia) is now available, at the cost of US$78 per person - with five more in development.[22] 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.[27][28]

See also

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References

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  1. ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7101108/
  2. ^ a b c "WHO | Dengue fever – Sri Lanka". WHO. Archived from the original on July 21, 2017. Retrieved 2020-11-27.
  3. ^ "CDC - Neglected Tropical Diseases - Diseases". www.cdc.gov. 2022-03-07. Retrieved 2022-10-28.
  4. ^ 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.
  5. ^ 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.
  6. ^ 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.
  7. ^ "What is a disaster? | IFRC". www.ifrc.org. Retrieved 2022-10-28.
  8. ^ 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.
  9. ^ a b c d "Trends". www.epid.gov.lk. Archived from the original on 2022-12-09. Retrieved 2022-10-28.
  10. ^ "Trends". www.epid.gov.lk. Retrieved 2020-11-27.
  11. ^ "Sri Lanka: Dengue Outbreak - Jul 2017". ReliefWeb. 21 August 2018. Retrieved 2020-11-27.
  12. ^ "Dengue Fever Outbreak in Sri Lanka Kills Nearly 300 People". Time. Retrieved 2020-11-27.
  13. ^ "Dengue and severe dengue". www.who.int. Retrieved 2022-10-28.
  14. ^ 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.
  15. ^ 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.
  16. ^ 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.
  17. ^ a b "Gapminder Tools". www.gapminder.org. Retrieved 2022-10-28.
  18. ^ 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.
  19. ^ a b "Sri Lanka - World Directory of Minorities & Indigenous Peoples". Minority Rights Group. 2019-06-19. Retrieved 2022-10-28.
  20. ^ Kapila, Mukesh (2018). "Healthcare in Conflict Settings". World Innovation Summit for Health. Retrieved 2022-10-28.
  21. ^ 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)
  22. ^ a b c WHO (2022). "Vaccines and immunization: Dengue". www.who.int. Retrieved 2022-10-28.
  23. ^ 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.
  24. ^ 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.
  25. ^ 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.
  26. ^ 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.
  27. ^ "Current health expenditure (% of GDP) - Sri Lanka | Data". data.worldbank.org. Retrieved 2022-10-28.
  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.