Browsing by Author "Dias, K.P.K."

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    An epidemiological study on a varicella outbreak among initial entry trainees of the Sri Lankan Army and the cost-effectiveness of vaccinating susceptible individuals
    (Sri Lanka College of Microbiologists, 2003) Dias, K.P.K.; Sunil-Chandra, N.P.
    INTRODUCTION: Varicella which is a disease burden to the Sri Lankan Army. VZV immunization of susceptible recruits is limited due to its high cost and therefore, recommendation of vaccination should be evaluated from a cost effectiveness perspective. OBJECTIVE: To study : 1. Spread of a varicella outbreak among initial entry trainees. 2. Usefulness of taking the past history of varicella for screening of susceptible individuals. 3. Cost effectiveness of VZV vaccination of initial entry trainees of the Sri Lankan Army. DESIGN: A hospital based descriptive study conducted prospectively over a period of three months during an outbreak. SETTING: 682 initial entry trainees aged 18-24 years who entered the Volunteer Force Training School of the Sri Lankan Army, Diyatalawa on 21!d July 2002 from various parts of the country were enrolled in this study. They were either hospitalized for varicella at the Army Base Hospital or billeted in the Camp. METHODS: Details of the index, secondary and tertiary cases, and preventive and management measures carried out for varicella patients were recorded. The rate of contracting varicella amongst immune and non-immune recruits based on past history were analyzed. A sample of blood was collected from some patients for the serological confirmation of varicella and rubelSa. Cost effectiveness of VZV vaccination at the Sri Lankan Army Hospital was analyzed. RESULTS: 263 (38.6 %) of all new recruits had a past history of chicken pox and only 9 (3.4%) of them re-infected. A total of 271 recruits were hospitalized for chicken pox during the outbreak and 262 (96.7%) of them did not have a past history. In addition to the varicella, there was also clinical and serological evidence of an outbreak of rubella Vaccination of recruits was found to be cheaper (Rs. 4293.00 or US$ 43.00) compared to the cost of 14 days of hospital stay (Rs. 7265.00 or US$ 72.00). CONCLUSIONS: Hospitalization and treatment of patients with varicella in the Army Hospital found to be more costly compared to the vaccination of susceptible recruits against VZV. Past history of varicella will be useful to identify susceptible new recruits for VZV immunization. Proper isolation of the patients and segregation of susceptible individuals at the index and secondary case levels will minimise the spread.
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    A Study on the appropriateness of current rabies post-exposure therapy in a government hospital of Sri Lanka
    (Sri Lanka College of Microbiologists, 2002) Dias, K.P.K.; Sunil-Chandra, N.P.
    OBJECTIVE: To assess the appropriateness of the use of anti-rabies vaccine and immunogfubulin therapy. DESIGN: A hospital based observational descriptive study conducted prospectively. SETTING: Patients receiving post exposure anti-rabies therapy at the Teaching Hospital, Ragama during the month of December 2000 were studied. METHODS: 500 persons seeking RPEP with a history of animal contact were selected by the non-probability sampling method and individually interviewed using a structured questionnaire. The information on the survival or death of the offending animal was obtained during the 14 day observation period. RESULTS: 500 exposed persons included 418 (83.6%), 61 (12.2%),16 (3.2%), 3 (0.6%) and 2 (0.4% ) due to dog, cat, rat, monkey and squirrel contacts respectively. 383 of 500 (77%) had been exposed due to observable animals and in 322 of 383 (84% ), the animal survived beyond the 14 day observation period. In contrast, only in 44 of 383 (11% ), the animal died. In 17of 383 ( 4%) persons exposed to observable animals, the information on death or survival of the animal was not available. The results show that complete RPEP in 61 of 500 (12.2%) cases could have been avoided based on the nature of exposure. In addition, the 4"1 and 5th vaccine doses of 322 of 500 (64.4%) cases too, could have been withheld as the animals responsible for the exposure cases survived beyond the 14 day observation. CONCLUSION: This study clearly shows that use of RPEP is often unnecessary and the expenditure on anti-rabies vaccines and immunoglubilins could have been minimised considerably by greater compliance with the use of proper RPEP guidelines. Education of doctors on logical implementation of RPEP guidelines and the co-operation by the public could optimise the use of this expensive resource in Sri Lanka.