Dengue Outbreak and Management of Control Measures in the National Hospital of Sri Lanka

patients admitted for other problems), and deaths (two It was observed that Ae. aegypti and Ae. albopictus were inward patients, and two staff members) occurred during breeding in a wide variety of natural and man-made this epidemic. The NHSL is a 3000-bed premier teaching containers (Brito Index >25 found most of the areas). The hospital and the tertiary care facility and providing a wide most preferred breeding sites of these vectors were spectrum of services. It is located on a 30-acre block of blocked or broken drainages, tyres, refrigerator trays, land; employees of nearly 7000 including 100 consultant metal ware, discarded containers, and roof gutters. staff and over 800 doctors. Similarly, the Sri Lankan studies showed that ground level

Dengue is a major public health problem in Sri Lanka.
of impending epidemics.Surveillance of dengue vectors is Globally, dengue is endemic in 112 countries.In Sri Lanka, important in determining the distribution, major larval in the year 2009 a major dengue epidemic with more than habits, spatial and temporal risk factors related to dengue 334 known deaths and 34,659 clinically/laboratory transmission and level of insecticide susceptibility or confirmed cases has occurred, and also in the National resistance 1.Therefore, a survey was conducted in the Hospital of Sri Lanka (NHSL) there were hospital acquired hospital with the assistance of the chief Epidemiologist, confirmed dengue cases (37 staff members, and 21 in-ward and Entomological staff of Medical Research Institute.patients admitted for other problems), and deaths (two It was observed that Ae. aegypti and Ae.albopictus were inward patients, and two staff members) occurred during breeding in a wide variety of natural and man-made this epidemic.The NHSL is a 3000-bed premier teaching containers (Brito Index >25 found most of the areas).The hospital and the tertiary care facility and providing a wide most preferred breeding sites of these vectors were spectrum of services.It is located on a 30-acre block of blocked or broken drainages, tyres, refrigerator trays, land; employees of nearly 7000 including 100 consultant metal ware, discarded containers, and roof gutters.staff and over 800 doctors.
Similarly, the Sri Lankan studies showed that ground level Dengue Vector water storage tanks and barrels are the most productive breeding sites of Ae. aegypti and Ae.Albopictus 2, and it Primary dengue vector in Sri Lanka is Aedes aegypti, and was reported that Thailand 3 had water storage tanks as the secondary vector is Aedes albopictus.These vectors can major breeding places of Aedes aegypti and Aedes breed even in a small quantity of water, and their eggs stick albopictus.to the walls of the container at the surface of the water.Therefore, eggs may not be removed even if the water gets

Hospital Dengue Prevention Committee removed. Even if the water gets dried, Aedes eggs can
New Hospital Dengue Prevention Committee was formed survive and may hatch even after a one year when water in NHSL.This committee conducted regular meetings, did gets collected again.Normally Aedes mosquitoes rest in regular weekly environmental inspection and took the dark places especially bushes.
necessary steps for elimination of breeding sites and vector Peak biting hours of Aedes Vectors control activities for dengue prevention.
Peak biting hours of the Aedes vectors 6.00 am to 10.00 The committee adopted the following basic principles to am, and 4.00 pm to 6.00 pm.Capable of biting several control the hospital acquired dengue epidemics: people in a short period for one blood meal, and the short a. Reduce the buildup of mosquito densities, flight range is < 200 meters.As Aedes is a day biter a usual b.Reduce the survival rate or the longevity of the mosquito net does not give a protection for indoor patients mosquito.to avoid dengue.c.Reduce or prevent man mosquito contact.Prevention of Dengue d.Identify and manage cases early.
In a tropical country, it is not possible to completely Conducted Dengue death review meetings, and identified eliminate the breeding or completely eradicate dengue short comings which were discussed with the consultants.when it becomes epidemics.The diseases could be Also Public Health Inspectors of NHSL did regular controlled and kept at levels, so that they will not cause inspections to identify breeding sites and reported to epidemics and become public health problems.
Dengue Prevention Committee for corrective action.

Training of Hospital Staff the National Hospital premises:
Training modeling of dengue risk based on sociocultural Most of the street vendors along the Regent Street were Data: Case of Jalore, Rajastan, India.Dengue disposing their garbage by throwing over the parapet wall Bulletin, 2001; 25:92-102 into the NHSL premises as there was no proper garbage disposal system for them.

Conclusion
In this hospital the epidemic was controlled (B.I. was < 10 to 0 in most of the breeding areas, and no new cases were reported) with hospital community participation and relevant inter and intra -sectoral collaboration.For any mosquito borne disease control programme to be successful, it should be well managed and be accepted by the community.Also, it should be sustainable and continue with full participation of the community.

Vector Control Activities Reference Continuous
Shramadana programs were conducted by 1. World Health Organization.Guidelines for dengue junior health staff and cleaning staff to control vector surveillance and Mosquito Control.Western breeding.These programs were conducted two days per Pacific Education in Action Series No. 8. World week at every unit of the hospital, and they sent progress Health Organisation Regional Office, Western reports to the Infection Control Unit.