Dengue 2018 Sri Lanka; news update

Dengue Fever is not going to go away! 2017 was a terrible year and one which showed quite clearly that the authorities did not have a grip on the disease. Will the number of new cases drop back from the 2017, highs or will dengue fever become even more entrenched?

Just Added: Cases per 000 of the population; see below

Watch this space

In this follow up to my earlier post Dengue Update I am going to analyse the figures on a monthly basis starting with January 2018. Most of what was written in the earlier article still holds true so this post is just about adding current information as it becomes available, together with all new material that is around on the web.

So the format for this post will be as follows:

  1. Cumulative total cases for Sri Lanka; running total compared with 2015, 2016, and 2017
  2. The top 10 worst affected districts

Sri Lanka Administrative districts

  1. Cumulative Total to date: to end February
  • 2015:    10,076
  • 2016:    11,133
  • 2017:    19,651
  • 2018:    11,162 (end Feb)

2.  Top Ten Hotspots as at 31/01

  1. Colombo          1773
  2. Gampaha         1,079
  3. Batticaloa        1,047
  4. Jaffna               934
  5. Puttalam          807
  6. Kurunegela      805
  7. Kalmunai         794
  8. Kandy              751
  9. Kalutara           675
  10. Ratnapura      306


So in February there was a spike in the number of cases in Western Province which probably reflects the time lag between the inter monsoon ending and the emergence of the mosquito larvae/mosquito breeding season

Batticaloa jumps from 4th to 3rd and it looks like they have another epidemic on their hands

Kalmunai has a bit of a spike has dropped to 7th

  • Compared with previous years the cumulative figures for  2018 offer some hope that the worst of the dengue epidemic may be passing. However, it is early days.
  • No surprise Colombo and Gampaha top the list of cases but there are some worrying signs:
  • Looks like dengue is re-establishing itself in Batticaloa; it is the wet season over on the east and the breeding time for mosquitos so that may explain the number of cases to some degree but the number is double what it was in January last year
  • Jaffna is also seeing a post North East Monsoon spike
  • Puttalam continues to record a large number of cases (only 196 in January last year)
Cases per 000 of the population

looking at the total number of cases is useful if you are planning for the number of medic, hospital beds, distribution of medication etc. However, to get an idea of the incidence and to be able to compare district with district you need to look at the numbers per 000 of the population; so see below; new table added. This gives a truer picture of where the virus is hitting hardest.

Census 2012 Population Cases per 000 2017 Cases per 000 2018 update every 3 months
Colombo 2324,349 14.9
Gampaha 2304833 13.7
Kalutara 1221948 9
Kandy 1375382 10.7
Matale 484531 6.5
Nuwara Eliya 711644 1.3
Galle 1063334 6
Hambantota 599903 6
Matara 814048 7.8
Jaffna 583882 10.4
Kilinochchi 113510 5
Mannar 99570 5.4
Vavuniya 172115 6.2
Mulativu 92238 4.2
Batticaloa 526,567 10.6
Ampara 649402 1.4
Trincomalee 379541 13.2
Kurunegala 1818465 6.2
Puttalam 762396 10.3
Anuradhapura 860575 3.4
Polonnaruwa 406088 3.5
Badulla 815405 4.5
Moneragala 451058 7.2
Ratnapura 1088007 10.4
Kegalle 840648 11.4
Kalmunai 106780 28.4

What you can see is:

  • The wetter west/south west has the higher rates per 000 of the population; as you may expect with 2 monsoons per year and higher population densities
  • but also it highlights the significant growth in the number of cases in the North and East. Jaffna is now becoming a dengue hotspot albeit the number of cases tails off during the dry season and both Batticaloa and Trincomalee suffered major epidemics last year
  • Kalmunai was a shock; highest of all! It is a muslim majority city in Ampara district so why the high incidence here? any suggestions?

Suggestion: if you are downloading this why not also download the admin districts map and map the top 5 or whatever on a monthly basis to see how the virus moves around and how new hotspots emerge.

To help with that

Just picked this up via a post on facebook; what does it mean? I guess it means that the virus is mutating and given the large number of folks affected in 2017 (and possibly 2018) the health risk from dengue fever is increasing, not decreasing! It isn’t just dengue anymore, it’s dengue with attitude! All the more reason for the authorities and the general public to get rid of the complacency that has typified the approach towards fighting this unpleasant disease.

“The behavior of Dengue Haemorrhagic Fever has changed drastically during the current dengue epidemic. We have encountered lot of children with abnormal disease behavior making it a real challenge to detect and manage the disease. The differences we observed are:
1. Patient entering the critical phase very early in the disease course (like day 2, even in day 1)
2. Commencement of the critical phase before platelet crossing 100,000/microlitre (Sometimes even far above 150,000/microlitre )
3. WBC count remaining high above 5000/microlitre throughout the disease course
4. Abnormally prolonged viraemia where both fever and NS1 postivity continues beyond 7th day of the illness.
5. Settlement of fever early in disease course, but platelets continuing to drop and patient entering critical phase later
6. Presence of Co-infection, mainly LRTI and tonsillitis which is misleading.
7. Abnormally short critical phase where patient enter recovery phase or equilibrium phase early ( Here risk is patient suffering fluid overload due to attribution of changes in parameters to critical phase. However we haven’t encountered prolonged critical phase much)
8. Rapid leaking where patient suffers shock within 12 hours without evidence of bleeding (we had one who suffered shock in 6 hours and had platelet count of 160000 and 9% rise in haematocrit at the time of event.)”