Typhoid Vaccination

Situation in Sri Lanka

Dr Paba Palihawadana MBBS, MSc (Com Med), MPH, MD (Com. Med)

Chief Epidemiologist,

Ministry of Health,

Sri Lanka

Epidemiology of Typhoid Fever in Sri

Lanka

12, 823 confirmed for the past 10 years in

Sri Lanka

More than half of these cases (51%) are

from 5 districts (Jaffna, Colombo, Vavuniya,

Nuwara-Eliya and Badulla).

(There are26 health districts in Sri Lanka)

1868

1612

1242

1340

1771

1296

1128

987

843

736

0

200

400

600

800

1000

1200

1400

1600

1800

2000

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Typhoid Fever Incidence in Sri Lanka No of Typhoid

Fever cases

Outbreak of Typhoid in IDP camps due to civil unrest in the country

Year Incidence Incidence Rate (per

100,000 population)

2005 1868 9.12

2006 1612 7.87

2007 1242 6.06

2008 1340 6.54

2009 1771 8.65

2010 1296 6.33

2011 1128 5.51

2012 987 4.82

2013 843 4.12

2014 736 3.59

Typhoid Fever Incidence and Incidence Rate in Sri Lanka

Outbreak of Typhoid in IDP camps due to civil unrest in the country

0

2

4

6

8

10

12

14

16

18

< 2

Y

2 -

5Y

5Y

-10Y

10-1

5Y

15-2

0Y

20-2

5Y

25-3

0Y

30-3

5Y

35-4

0Y

40-4

5Y

45-5

0Y

50-5

5Y

55-6

0Y

60-1

20

Incidence Rate per 100,000

Age Specific Typhoid Fever Incidence Rates in Sri Lanka

2010-2014

Age Specific

Incidence Rate

Age Category

Highest Incidence

in10-15Y age

group –(15.6%)

83% of cases

in 5-50Y age

group

58

99

114

122

125

133

146

157

162

196

238

262

386

408

427

467

509

518

550

561

646

671

1010

1028

1242

2588

0 500 1000 1500 2000 2500 3000

Ampara

Hambantota

Kilinochch

Galle

Mullativu

Anuradhapu

Trincomale

Polonnaruwa

Kalmunai

Batticaloa

Matale

Matara

Monaragala

Kegalle

Kandy

Gampaha

Kalutara(N

Mannar

Kurunegala

Puttalam

Ratnapura

Badulla

Nuwara-Eli

Vavuniya

Colombo

Jaffna

Typhoid Fever Incidence in Sri

Lanka

by District, 2005-2014

6

12

12

17

19

19

23

23

27

28

30

32

34

41

44

50

60

61

63

73

75

77

109

195

449

0 50 100 150 200 250 300 350 400 450 500

Anuradhapu

Galle

Trincomale

Hambantota

Ampara

Polonnaruwa

Mullativu

Puttalam

Badulla

Monaragala

Nuwara-Eli

Matara

Matale

Batticaloa

Kilinochch

Kurunegala

Ratnapura

Mannar

Kandy

Kegalle

Vavuniya

Gampaha

Kalutara(N

Colombo

Jaffna

Typhoid Fever Incidence in Sri Lanka

by District, 2013-2014

Typhoid Fever incidence in Sri Lanka

by District, 2005-2014

District Incidence

Jaffna 2588

Colombo 1242

Vavuniya 1028

N’Eliya 1010

Badulla 671

Typhoid Fever incidence in Sri

Lanka

by District, 2013-2014

District Incidence

Jaffna 449

Colombo 195

Kaluthara 109

Gampaha 77

Vavuniya 75

Typhoid Fever Incidence Rate in Sri

Lanka

by District, 2005-2014

District Incidence

Rate

Vavuniya 59.73

Mannar 52.02

Jaffna 44.32

Nuwara-Eliya 14.19

Mullativu 12.6

Typhoid Fever Incidence Rate in Sri

Lanka

by District, 2013-2014

District Incidence

Rate

Jaffna 38.45

Mannar 30.63

Vavuniya 21.79

Kilinochchi 19.38

Mullativu 11.59

Control Strategies adopted in Sri

Lanka..

Disease Surveillance

Health Education

Typhoid Vaccination

Water Quality Surveillance

Disease Surveillance system in Sri Lanka

Typhoid is a notifiable disease under the

routine disease surveillance system

Every medical practitioner or person professing to treat diseases, who attends on any person suffering from any disease in the notifiable diseases list shall notify the relevant Medical Officer of Health(MOH).

Disease Surveillance system in Sri Lanka...

Health Districts in Sri Lanka are divided in

to Medical Officer of Health (MOH)

areas.

These MOH areas are headed by one or

more medical doctors.

There are Public Health Inspectors (PHII)

attached to the MOH office, and these

PHII carry out disease control activities

under the guidance of the MOH

Control Strategies adopted in Sri Lanka..

Health Education

Typhoid vaccine

Inactivated Whole Cell Typhoid vaccine was

manufactured in Sri Lanka for over four

decades before stopping in 2004

Both injectable Vi capsular polysaccharide

vaccine and Ty21a oral vaccine are registered .

A total of 268,200 injectable Typhoid vaccines

doses were distributed by MoH from 2010-

2014

Sri Lanka is currently using Vi capsular polysaccharide

vaccine

Typhoid vaccine.. Typhoid vaccine is being administered to

Food handlers

Pilgrims who visit areas with high Typhoid Fever incidence.

Internally displaced persons living in temporary shelters.

Close contacts of typhoid patients ( eg. family members)

Children getting frequent episodes of diarrhoea (eg. more than 4 attacks in preceding six month)

Communities that do not have access to safe water.

Health care workers associate with typhoid patients.

Pre-Employment administration of Typhoid Vaccine was mandatory

in Sri Lanka earlier

0

20000

40000

60000

80000

100000

120000

140000

160000

0

200

400

600

800

1000

1200

1400

2010 2011 2012 2013 2014

Typhoid Incidence

No of Vaccines

Typhoid Incidence Typhoid Fever incidence VS

Vaccination No of Vaccines given

Water Quality Surveillance in Sri Lanka

Water samples are

analyzed in the

National Reference

Laboratory and 5

Regional

Laboratories-Since

2011and ongoing

6 Water samples

from an MOH area

per month

NRL

Water Quality-2012

47.08480565

52.91519435

Satisfactory

Unsatisfactory

Total No of Water samples-3396

Water Quality-2012…

Source No of samples

tested

Satisfactory (%) Unsatisfactory(%)

NWS&DB 558 431 (77.2) 127(22.8)

CWS 1069 558 (52.2) 511 (47.8)

PW 1239 364 (29.4) 875 (70.6)

Others 530 246(46.4) 284 (55.6)

NWS&DB-National Water Supply and Drainage Board

CWS-Community Water Supplies

PW-Private Wells

Water Quality-2013

50.39854247

49.60145753 Satisfactory

Unsatisfactory

Total No of Water samples-4391

Water Quality-2013…

Source No of samples

tested

Satisfactory (%) Unsatisfactory(%)

NWS&DB 684 521 (76.1) 163 (23.9)

CWS 1254 557 (44.3) 700 (55.7)

PW 1214 522 (43.0) 692 (57.0)

Others 1236 613 (49.6) 623 (50.4)

NWS&DB-National Water Supply and Drainage Board

CWS-Community Water Supplies

PW-Private Wells

Water Quality-2014

Total no of Water

Samples-5607

Water Quality-2014

Source No of samples

tested

Satisfactory (%) Unsatisfactory(%)

NWS&DB 744 545 (73.3) 199 (26.7)

CWS 1920 909 (46.9) 1031 (53.1)

PW 1395 679 (48.7) 716 (51.3)

Others 1528 847(55.4) 681 (44.6)

NWS&DB-National Water Supply and Drainage Board

CWS-Community Water Supplies

PW-Private Wells

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

Analysis of Water Samples -2014

This may be a biased samples-Most of the water samples were collected from

Water sources which were suspected of being contaminated

Percentage of

satisfactory

samples

Control Strategies adopted in Sri Lanka..

Special surveillance of typhoid in selected

sentinel sites hospitals

Antibiotic sensitivity patterns are

assessed routinely

Way forward

Strengthening of Sentinel Site Surveillance

system and laboratory diagnosis

Wider use of antibiotic sensitivity

patterns when treating typhoid fever

patients

Immunization Campaigns in high risk

areas for high risk age groups- in Jaffna