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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]

Forty-three percent of cases 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 below), 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 2017 and peaking in July of the same year.[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 $12 million (US dollars; USD) on outbreak control efforts, with support from non-governmental organizations (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.[1 The 2017 monsoon rains (May–August) coincided with the peak of the dengue outbreak. Triggering floods and disrupting refuse collection, increased mosquito breeding sites.[2][3] However, annual rainfall and El Nino conditions were lower on average than previous years, suggesting that the climate was not completely responsible for the outbreak.[4]

Political

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MoH failed to prepare and take appropriate mosquito vector control actions.[5][6] Insufficiencies in the virologic surveillance program failed to identify dengue serotypes and genotypes[5][2][7] leaving Sri Lanka unprepared for new strains (DENV-2), for which their population would have little immunity.[8][4][7]

Socio-economic

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Sri Lanka is a middle-income country with a gross domestic product (GDP) per capita of $12,600 USD (2017).[9] This restricts investment in healthcare infrastructure, resulting in an overstretched healthcare system.[2] High urban population density in Western districts created a higher probability of transmission.[4] In 2017, 42% of Sri Lankans were in extreme poverty (below $5.50 USD a day) which limits a family's access to healthcare and increases the risk of disease.[9][10] Regional disparities, due to the Sri Lankan civil conflict (1983-2009), displaced people to internally displaced persons (IDP) camps and marginalized ethnic groups (Tamils) in North and Eastern districts, reducing support and increasing disease risk.[11][12]

Impacts

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Short-term impacts

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The fever brought an unexpected high death toll. Along with the death toll, it also caused disruption to workplaces, household income, and education as the majority of cases were people aged 10–29.[1] Direct and indirect impacts of the dengue outbreak affected 600,000 people in all 25 districts, prominently in urban areas. Some districts, however, may have been under-reported due to ethnic marginalization and the presence of IDP camps.[11][13] Dengue treatment put pressure on national economic resources, costing Sri Lanka LKR 1.938 billion ($12.7 million USD).[1]

Long-term impacts

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Today, dengue cases are declining in Sri Lanka, with 25,067 total cases in 2021.[14] Dengue is still present with new strains (serotypes DENV-3 and DENV-4) becoming more prominent and threatening future outbreaks.[7] Combined with the COVID-19 pandemic, there is still immense pressure on healthcare and trade networks.[citation needed] The year 2022, has seen an economic crisis and severe food insecurity in Sri Lanka; the dengue outbreak would be a contributing factor.[15]

Future

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Climate change models suggest that Sri Lanka's climate is becoming more conducive to mosquito breeding and this combined with economic instability could trigger a future epidemic.[13][14] There is a possibility that a cycle of disease, poverty, and food insecurity may be challenging to break.[15] However, this could be mitigated if the MoH, supported by institutions like the World Health Organization (WHO), engage in proactive strategies.[16] A licensed vaccine (Dengvaxia; made by Sanofi Pasteur) is now available, at the cost of $78 USD per person - with five more in development.[16] However, Sri Lanka's current expenditure is $161 USD per capita on healthcare (2021), and the vaccine is a significant proportion of that budget and in uncertain economic times, may not be a priority.[17][18]

See also

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References

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  1. ^ a b c Tissera, H. A.; Jayamanne, B. D.; Raut, R.; Janaki, S. M.; Tozan, Y.; Samaraweera, P. C.; Liyanage, P.; Ghouse, A.; Rodrigo, C.; De Silva, A. M.; Fernando, S. D. (2020). "Severe Dengue Epidemic, Sri Lanka, 2017". Emerging Infectious Diseases. 26 (4): 682–691. doi:10.3201/eid2604.190435. PMC 7101108. PMID 32186490.
  2. ^ "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. ^ 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. ^ 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 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. ^ a b "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 "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. ^ a b "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. ^ 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.
  14. ^ a b 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.
  15. ^ a b 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.
  16. ^ a b WHO (2022). "Vaccines and immunization: Dengue". www.who.int. Retrieved 2022-10-28.
  17. ^ "Current health expenditure (% of GDP) - Sri Lanka | Data". data.worldbank.org. Retrieved 2022-10-28.
  18. ^ 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.
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