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Sepsis is a major cause of mortality and morbidity in neonates. With the improvement in health care standards, the incidence of neonatal Early Onset Sepsis (EOS) has reduced significantly. A recent Web-based EOS-calculator has been introduced with the aim to reduce the use of IV antibiotics in neonates. The role of the EOS-calculator has yet to be ascertained in this regional Special Care Nursery (SCN) in Western Australia. This study aims at examining the local incidence of culture proven EOS and the role of the EOS calculator.It is a retrospective study examining all newborns ≥35 weeks gestation throughout 2019 (Jan-Dec 2019) who received IV-antibiotics. The local incidence of culture-proven EOS was established and applied onto the EOS calculator. The recommended management by the EOS-calculator was cross-examined with the local EOS guideline. Overall proportion of reduction in IV antibiotics use was formulated. Other relevant laboratory data extracted was analysed with Pearson's correlation test with the EOS scores.Total included sample was n = 252 with an annual birth of 1880s indicating 13.4% of all neonates born throughout year 2019 was treated with IV antibiotics. The local incidence of culture-proven EOS was 0.5/1000. By applying the EOS-calculator, a significant reduction of IV antibiotics usage from 13.4% to 3.9% (z value 10.4, p 0.0001) could be achieved in this cohort. Sixty three percent of neonates who received IV antibiotics in this cohort were classified as 'clinically well' based on the EOS-calculator.The EOS-calculator could reduce the use of IV antibiotics in the neonatal population significantly in this regional SCN (from 13.4% to 3.9%). Judicial use of IV antibiotics is imperative as part of the holistic care for the neonates. Implementation of the EOS-calculator must be done strategically considering the local incidence of EOS and other health care policies.

With an estimated 229 million malaria cases being reported in 87 malaria-endemic countries in 2019, malaria continues to be a major public health problem. Following a decline of the malaria cases to near zero in 1963, malaria re-emerged as a public health problem in Sri Lanka in 1967. Despite the persistence of the vector, Sri Lanka interrupted malaria transmission and achieved zero indigenous cases since 2012. The certification of elimination from the World Health Organization was received in 2016.

Background. Early detection of dengue epidemics is a vital aspect in control programmes. Predictions based on larval indices of disease vectors are widely used in dengue control, with defined threshold values. However, there is no set threshold in Sri Lanka at the national or regional levels for Aedes larval indices. Therefore, the current study aimed at developing threshold values for vector indices in two dengue high-risk districts in Sri Lanka. Methods. Monthly vector indices (House Index [HI], Container Index [CI], Breteau Index for Aedes aegypti [BIagp], and Ae. albopictus [BIalb]), of ten selected dengue high-risk Medical Officer of Health (MOH) areas located in Colombo and Kandy districts, were collected from January 2010 to June 2019, along with monthly reported dengue cases. Receiver Operating Characteristic (ROC) curve analysis in SPSS (version 23) was used to assess the discriminative power of the larval indices in identifying dengue epidemics and to develop thresholds for the dengue epidemic management. Results. Only HI and BIagp denoted significant associations with dengue epidemics at lag periods of one and two months. Based on Ae. aegypti, average threshold values were defined for Colombo as Low Risk (2.4≤BIagp<3.8), Moderate Risk (3.8≤BIagp<5), High Risk (BIagp≥5), along with BIagp 2.9≤BIagp<4.2 (Low Risk), 4.2≤BIagp<5.3 (Moderate Risk), and BIagp≥5.3 (High Risk) for Kandy. Further, 5.5≤HI<8.9, 8.9≤HI<11.9, and HI≥11.9 were defined as Low Risk, Moderate Risk, and High Risk average thresholds for HI in Colombo, while 6.9≤HI<9.1 (Low Risk), 8.9≥HI<11.8 (Moderate Risk), and HI≥11.8 (High Risk) were defined for Kandy. Conclusions. The defined threshold values for Ae. aegypti and HI could be recommended as indicators for early detection of dengue epidemics and to drive vector management activities, with the objective of managing dengue epidemics with optimal usage of financial, technical, and human resources in Sri Lanka.

This study was conducted to evaluate the potential of six locally abundant fish species to control Aedes mosquito larvae and thereby manage dengue epidemics in a sustainable, cost-effective and environmentally friendly manner. The biocontrol efficacy of six larvivorous fish species, namely, Poecilia reticulata, Rasbora daniconius, Aplocheilus dayi, Oriochromis mossambicus, O. niloticus and Puntius bimaculatus, was evaluated under laboratory and field conditions. Five size-matched fish (of the same species) were introduced into separate tanks (replicates) containing 2 L of dechlorinated water and 200 third instar larvae of Aedes aegypti (L.). The number of larvae consumed by each fish species was recorded at three-hour intervals for 24 h. Acclimatized fish were introduced into a total of eighteen artificial breeding habitats located in the Gampola Medical Officer of Health (MOH) area at the species level with three replications. In addition, three breeding sites without fish were monitored as controls. Aedes larvae were monitored by dipping and siphoning methods in each breeding habitat at weekly intervals for three months and the number of fish surviving in each habitat was tallied. Over 24 h under laboratory conditions, O. mossambicus showed the highest predation rate, consuming 320.2 ± 14.5 larvae per day, with a predatory efficiency of 87.5 ± 3.5%. In comparison, O. niloticus consumed 264.6 ± 12.2 larvae per day with consumption efficiciency of 78.1 ± 3.7%, whereas R. daniconius had the lowest larval consumption (33.2 ± 2.7 larvae per day) and predatory efficiency (33.2 ± 3.2%). Over 12 weeks of observation under field conditions, breeding sites with Ap. dayi had the lowest Aedes larval counts, followed by Po. reticulata. Considering predation efficiency and survival under field conditions, Ap. dayi and Po. reticulata were considered to be the best potential candidates for biological control of Ae. aegypti. Further studies under field settings are warranted to evaluate the survival and predatory potential of the selected candidates under more varied environmental conditions.

Objective: To revise morphological identification keys to the anophelines in Sri Lanka. Method: Samples were collected from selected entomological sites in different districts in the country. Stage III and IV larvae were identified under a light microscope with an objective (× 10) using standard larval keys developed for Sri Lankan anophelines. Key larval characters were recorded for each species based on original observations and previous usage in literature. Results: This manuscript describes an illustrated key for the identification of 22 of 23 mosquitoes which are currently recognized as local anopheline species in Sri Lanka, as a guide to workers engaged in malaria surveillance and control in the country. Conclusions: Revised morphological keys to the larval of these species may be helpful in easy and accurate identification at the field level.

Background Anopheles culicifacies, the major vector of malaria in Sri Lanka, is known to breed in clean and clear water. The main objective of the study was to detect the breeding habitat diversity of An. culicifacies. Methods Potential larval habitats for Anopheles mosquitoes were surveyed on a monthly basis for 17 months (January 2011–June 2012) in four different selected sampling sites (Murthankulam, Kommnaimottai, Paranamadawachchiya and Kokmotawewa) in Trincomalee District of Sri Lanka. Results A total of 2,996 larval specimens representing 13 Anopheles species were reported from 16 different breeding habitats. According to density criterion, An. culicifacies, Anopheles subpictus, Anopheles barbirostris, Anopheles peditaeniatus and Anopheles nigerrimus were dominant. Anopheles nigerrimus, An. subpictus and An. peditaeniatus were observed as constant in relation to their distribution. The most productive breeding site for An. culicifacies was drains filled with waste water in remote areas; the second highest productivity was found in built wells. Conclusions These results indicate that An. culicifacies has adapted to breed in a wide range of water bodies including waste water collections although they were earlier considered to breed only in clean and clear water.