1. JE surveillance in Sri Lanka country presentation for the 5th Bi-regional meeting on JE prevention and controlDr. Pushpa Ranjan Wijesinghe National Surveillance Focal Point Epidemiology Unit, Ministry of Health

2. Uses of surveillance data Quantification of the disease frequency in the country Information from 1985 to date Identification of JE endemic areas in the country Phase based immunization in 1989 Identification of high risk groups for targeted vaccination 1-10 age group till 2009 Forecasting and Identification of JE outbreaks Last major outbreak in 2002 (Ratnapura) Designing and implementation of the JE control programme Vector control and IEC before 1889 Immunization program from 1989Evaluation of the JE control programme 3. Current use of surveillance data Determination of the changing epidemiology Sporadic nature of cases since 2003 Changing age profile of JE cases Spatial change in disease transmission among humans Effectiveness of the immunization campaign Verification of mounting rumors and anecdotal evidence that JE is on rise Clinical fraternity , media Appraisal of the effectiveness of the LJEV Is the efficacious vaccine effective in the real world ? Is one dose strategy the correct approach ? 4. Methods of Acute Encephalitis Syndromic surveillance Routine communicable disease surveillance Acute Encephalitis - a notifiable disease Notification by all medical practitioners Notification on the basis of the tentative diagnosis Availability of surveillance case definition 100% field investigation by the Public Health Inspector Information to the national data base through the weekly Return of Communicable Disease Feed back of weekly consolidated information through the Weekly Epidemiological Report 5. Methods of Acute Encephalitis Syndromic surveillance Event Based Surveillance Media surveillance for reported communicable disease outbreaks / clusters at the national level Central rumour register District rumour registers maintained by Regional Epidemiologists Confirmation by the peripheral staff Event assessment by the Regional Epidemiologist with central support 6. Methods of Acute Encephalitis Syndromic surveillance Casebased Special Surveillance Case based surveillance of all AES cases including JE Obtaining in-depth information than through routine notification Demographic, epidemiological, clinical , immunization and risk factors 100% mandatory investigation of JE cases Entry into the National JE registry Quarterly Feed back in the Quarterly Epidemiological Bulletin Annual surveillance information through the Annual health bulletin 7. Methods of Acute Encephalitis Syndromic surveillance Laboratory surveillance Sentinel hospitals based National JE Reference Laboratory - Viral Laboratory at the Medical Research Unit Accredited laboratory Tests used Detection of Ig M in serum and CSF 8. EPIDEMIOLOGICAL INFORMATION 9. JE specific morbidity Rate [per 100,000] & Case Fatality Ratio (%), 1985-2010100101 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 0 Morbidity 0.1CFR123456789 10 10. Distribution of suspected and confirmed JE cases Confirmed JE YearSuspected No.%20061302620.020072033919.220082613111.820092233415.220102152712.5 11. Results of laboratory surveillance Total Number of AES Specimens Received in LabNumber of Positive ResultsYear SerumCSFSerumCSFReceivedTestedReceivedTestedJE PositiveJE Positive200914214256856815 ( 9.4%)23 ( 4.1%)20101681685585588( 4.7%)19 (3.4%)201143431871873( 6.9%)12( 6.4%) 12. Seasonal trend of AES reporting in Sri Lanka 2006 200750 45 40 35 30 25 20 15 10 5 020082009 2010Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 13. Seasonal trend of JE reporting in Sri Lanka 16 14 12 20061020078200862009 20104 2 0 JanFebMarAprMayJuneJulyAugSepOctNovDec 14. Spatial distribution of suspected and confirmed JE 2010Reported AES casesConfirmed JE cases 15. Age distribution of confirmed JE cases Age groupYear 20062007200820092010604(15.2%)5 (13%)7(22.4%)2(5.9%)5(18.5%)Unknown3(11.4%)4 (10.4%)2 (6.4%)2(5.9%)0(0.0%)Total2639313427 16. Confirmed JE cases by immunization status 17. Challenges Waning interest of the policy and decision makers on JE declined disease burden competing priorities Improving the quality of surveillance information related to auxiliary laboratory investigations Improving the coverage of specimens sent for confirmation of JE from sentinel hospitals Sustainable logistics supply to the national reference laboratory Improvement of etiological diagnosis of AES other than JE Establishing sustainable private sector reporting 18. Solutions Quarterly surveillance reviews at the Advisory Committee of Communicable Diseases Quarterly meeting of Regional Epidemiologists District level reviews by Regional Epidemiologists Mandatory investigation by Medical officers of Health 100% case- based investigation for all confirmed JE cases Complimentary lab information from the sentinel hospitals Discussions with the clinicians and professional bodies Back up funding from cost-savings and donor agencies Proposed new system of mandatory reporting of aetiology by virologists and microbiologists for all tested AES specimens 19. Acknowledgements Dr. Paba Palihawadana Chief Epidemiologist Dr.T.S.R. Pieris EPI focal point Dr.Geethani Galagoda - JE laboratory focal point , MRI Colombo Dr. Chatura Edirisuriya Registrar in Public Health Nipuni, Roshan and Inoka - JE surveillance team Dr. Nihal Abeysinghe -WHO/SEAR