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11/14/2013
1
MERS Preparedness in Sri Lanka
Jude Jayamaha
Consultant Virologist, Head
National Influenza Centre
Sri Lanka
Outline
• Demography
• Existing Surveillance system
• Importance of MERS preparedness in SL
• MERS specific
• Challenges
11/14/2013
2
General Information
Population, Land Area
Land Area(Sq. Km)
Population Average Annual Growth
Rate
Density (Person per Sq.
Km)
Crude birth rate
Maternal mortality rate
Crude death rate
65,565 21
million
1% 323.1 18.8 Per 1000
populatio
n
14.3 Per 100,0
00 live
births
5.84 Per 1000
populatio
n
Life expectancy 75.94 years (2012 est.)
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3
• Ethnicity (%)
Sinhala 75% Tamil 15% Moors 9% Others 1%
• Religion (%)
Buddhism 69% Hinduism 15% Christianity 8% Islam 7%
• Climate Warm and Humid
two monsoon seasons
Administrative Units
9 Provinces
25 Districts
256 Divisional Secretariats
160 Electorates
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4
Outline
• Demography
• Existing Surveillance systems
• Importance of MERS preparedness in SL
• MERS specific
• Challenges
Influenza Surveillance
• Started in 2004 in collaboration with Ministry of Livestock
Development (MoL)
• Guided by respective national plans;
National Influenza Preparedness Plan (NIPP) of MoH and
Sri Lanka Exotic Disease Emergency Plan (SEDEP) of
DAPH
• Supervised & coordinated by National Technical
Committee on Pandemic/Avian Influenza
Preparedness chaired by respective DG of MoH and
DAPH Committee has all stakeholders of Pandemic
preparedness as members
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5
Influenza Surveillance
• Human Surveillance
Epidemiological
Virological
• Animal Surveillance
• Pneumonia unknown aetiology
Influenza Surveillance
• Human Surveillance well established
,quality
Epidemiological
Virological
funded by CDC
-ILI
19 sentinel sites OPD
– SARI 3 sites
Informed specimen collection & transport
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6
Sentinel sites
Western 1. NHSL- National
2. LRH - Children's
3. CSTH- South
4. IDH-
5. NCTH- North
Central 6. TH Peradeniya
7. GH Nuwara Eliya
Southern 8. TH Karapitiya
9. GH Matara
Northern 10. TH Jaffna
11. GH Vavuniya
Eastern 12. GH Ampara
13. TH Batticaloa
North Western 14. TH Kurunegala
15. GH Chilaw
North Central 16. TH Anuradhapura
17. GH Polonnaruwa
Uva 18. GH Badulla
Sabaragamuwa 19. GH Rathnapura
SARI sites
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7
Virological Surviellance
2010-2013 Sep.
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Pe
rce
nta
ge
%
Month
2010 2011 2012 2013
National Influenza Centre
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8
Outline
• Demography
• Existing Surveillance system
• Importance of MERS preparedness in SL
• Preparedness Measures
• Challenges
11/14/2013
9
Importance of MERS
preparedness in Sri Lanka
implications of the huge contingent of Middle-
East workers from Sri Lanka,
Asian Development Bank Institute and Organization for Economic Coorporation and Development, Managing Migration to Support Inclusive and Sustainable Growth Tokyo: Asian Development Bank Institute 56 2013.
• substantial Muslim population going to Haj
Importance of MERS
preparedness in Sri Lanka
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10
• increasing tourist arrivals from Middle-East
on the introduction of the infection to the
country
Wickramage K et al F1000Research 2013, 2:163
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11
Importance of MERS preparedness
in Sri Lanka
• regional/global impact if the infection is established in Sri Lanka given the high tourist boom .
Outline
• Demography
• Existing Surveillance system
• Importance of MERS preparedness in SL
• Preparedness Measures
• Challenges
11/14/2013
12
Preparedness
Measures
MERS
Guidelines
Diagnosis
Reagents
(PC)
Surveillance
Lab
capacity
/protocols
IHR
Case
Management
Guidelines
• for Appearance of Cases of Middle East
Respiratory Syndrome - Corona Virus (MERS-CoV) Infection - Alert to Hospitals
• on collection and transportation of specimens from patients
• for Clinical Management of Patients
Circulars, website, workshops
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13
Surveillance on MERS-CoV
• At high risk as a large population travel regularly to
Middle Eastern countries for employment, pilgrimages (Haj-Umra) & trade
• Awareness among Haj-Umra pilgrims and Middle East workers heightened - through an informative
leaflet distributed through mosques and travel agencies
• Staff at PoE educated
• Awareness among workers going for Middle East employment – Foreign Employment Bureau
• Hospitals alerted for case notification & surveillance
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14
Case Definition
A person with acute respiratory tract infection (with fever >380C and cough)
AND
Radiological or clinical evidence of pneumonia
AND
Residence in or history of travel to Middle Eastern Countries within past 14 days AND
Illness not already explained by any other infection or aetiology
Laboratory MERS-CoV
Realtime PCR
Primers, probes & NIV-Pune, India t’h WHO
SEARO
Consumables, VTM
1st tested on 21.03.2013
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15
Nine runs on 6 patients with case
definition all negative (2- Inf A positive)
IHR-Risk communication
• Timely public awareness through mass media
(print, electronic and web based)
also was on Inf luenza A(H1N1)pdm09, pandemic, H5N1 Avian
inf luenza
• Special mechanisms used for vulnerable
groups
e.g. Leaflet on MERS-CoV to Middle East
travelers through mosques
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16
IHR-Points of Entry
• IHR Country action document developed
• Relevant staff educated on IHR issues
e.g. Airport and Port staff
• Voluntary presentation at PoE
Quarantine-Health Desk
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17
Case management and
Infection Prevention and Control
• Response mechanism strengthened by
distributing case management and
infection control protocols developed &
distributed to all hospitals with ICUs
• Hospital staff (all) training
• Logistics (PPE) and infrastructure
(isolation unit _Infectious Dis. Hospital)
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18
Outline
• Demography
• Importance of MERS preparedness in SL
• Existing Surveillance system
• MERS specific
• Issues, challenges
Issues, challenges
• supply of MERS lab reagents in an
outbreak, delayed custom clearance
• Pneumonia unknown aetiology surviell
• Proper laboratory biorisk management,
• Training on testing (new staff)
• If O/B occurs managing cases in other
ICUs
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19
Collaborators
• WHO country office, SEARO
• CDC, Atlanta, USA
• WHO Collaborating Centre, Melbourne
Prof Malik Peiris University of Hong Kong
Acknowledgments
• SEARO, SL WHO - Dr Aprna Singh Dr
Janakan
• NIV, Pune Dr Mourya
• Dr Geethani Wickramasinghe – former
Head, NIC
• MoH Sri Lanka Director General
• Staff - - NIC and Dept Virology
- Epid Unit AI cell
• AI advisory Committee