Browsing by Author "Hevawitharana, M."

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    The first case of introduced malaria in Sri Lanka after elimination: Approach by the Anti Malaria Campaign to prevent re-establishment of malaria
    (Sri Lanka Medical Association., 2019) Karunasena, V.M.; Marasinghe, M.M.M.B.; Amarasinghe, S.; Senaratne, P.A.S.; Hasantha, M.B.R.; Hevawitharana, M.
    INTRODUCTION & OBJECTIVES: Apart from imported malaria infections Sri Lanka has been free of malaria cases for the past six years after elimination until December 26th 2018, when the first introduced case was reported. This manuscript describes the probable index case and the introduced case of malaria, and actions taken to curtail the spread of transmission. METHODS: Detailed case investigations of the probable index and introduced cases were carried out and appropriate responses were mounted by the Anti Malaria Campaign (AMC). Genome sequencing was performed on parasites obtained from the two cases to determine relatedness of the two parasite isolates. RESULTS: An Indian employed at a construction site in Moneragala district, developed a Plasmodium vivax infection 23 days after arriving in Sri Lanka. Thirteen days later a Sri Lankan with no travel history to a malaria endemic country was diagnosed with P.vivax malaria following his visit to the same site. Multi-locus genome sequencing show that P. vivax strains obtained from these cases share 100% genetic identity at five loci of three polymorphic genes (CSP, MSPI and MSP3a genes), suggesting that both patients were infected with the same P.vivax strain. AMC mounted a rapid response including parasitological and entomological surveillance, active case detection, appropriate vector control measures and raising public and clinician awareness at relevant sites. CONCLUSION: An outbreak and the re-introduction of malaria to Sri Lanka from an index and introduced cases were prevented by prompt interventions which illustrate a very effective surveillance and response system.
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    Technical and operational underpinnings of malaria elimination from Sri Lanka
    (BioMed Central, 2019) Premaratne, R.; Wickremasinghe, R.; Ranaweera, D.; Gunasekera, W.M.K.T.A.W.; Hevawitharana, M.; Pieris, L.; Fernando, D.; Mendis, K.
    Malaria was eliminated from Sri Lanka in 2012, and the country received WHO-certification in 2016. The objective of this paper is to describe the epidemiology of malaria elimination in Sri Lanka, and the key technical and operational features of the elimination effort, which may have been central to achieving the goal, even prior to schedule, and despite an ongoing war in parts of the country. Analysis of information and data from the Anti Malaria Campaign (AMC) of Sri Lanka during and before the elimination phase, and the experiences of the author(s) who directed and/or implemented the elimination programme or supported it form the basis of this paper. The key epidemiological features of malaria on the path to elimination included a steady reduction of case incidence from 1999 onwards, and the simultaneous elimination of both Plasmodium falciparum and Plasmodium vivax. Against the backdrop of a good health infrastructure the AMC, a specialized programme within the Ministry of Health operated through a decentralized provincial health system to implement accepted strategies for the elimination of malaria. Careful planning combined with expertise on malaria control at the Central level with dedicated staff at all levels at the Centre and on the ground in all districts, for several years, was the foundation of this success. The stringent implementation of anti-relapse treatment for P. vivax through a strong collaboration with the military in whose cadres most of the malaria cases were clustered in the last few years of transmission would have supported the relatively rapid elimination of P. vivax. A robust case and entomological surveillance and investigation system described here enabled a highly focused approach to delivering interventions leading to the interruption of transmission.