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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

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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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• 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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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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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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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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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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Outline

• Demography

• Existing Surveillance system

• Importance of MERS preparedness in SL

• Preparedness Measures

• Challenges

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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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• 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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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

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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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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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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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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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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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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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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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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

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May you live long