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Introduction: Chronic Kidney Disease (CKD) has significant economic impact on both patients’ households and the country. Objectives: To assess the out-of-pocket (OOP) expenditure of accessing health services among CKD patients in Anuradhapura District. Methods: This community based cross-sectional study included a representative sample of 1174 registered CKD patients from all 19 Medical Officer of Health areas in the district of Anuradhapura. Trained para-medical staff visited the households and administered an interviewer administered questionnaire to gather information. Results: A total of 1118 CKD patients participated. Mean age was 58.3 (SD 10.8) years. Fifty nine (5.3%) patients had been hospitalized during the six months preceding data collection. The total OOP for a hospital admission for one patient was Rs.3625 (IQR 1650-8760). Thirty eight (3.4%) patients were on dialysis. The median direct cost per patient for an episode of dialysis was Rs.595 (IQR 415-995) while the median direct cost for a dialysis patient per month was Rs.5490 (IQR 3950-10934). In the study population a total of 1095 (98.0%) had attended clinic at least once during the six months preceding the study. The OOP expenditure for a single clinic visit for one patient was Rs.434 (IQR 200-860). Conclusions: CKD patients living in Anuradhapura district spend significant amounts on accessing health care which can worsen their economic hardships. Planned interventions are warranted in order to improve their quality of life and financial situation.

Introduction: Dengue has become a major public health problem in Sri Lanka; however, the economic impact of the disease has not been studied in this setting. This study assessed the costs of dengue prevention and control activities and the direct medical costs of dengue hospitalizations in the Colombo District, the most affected district with the highest dengue caseloads in the country. Methods: The study was conducted in the epidemic year of 2012. Using information from the official databases of governmental agencies in charge of the dengue prevention and control activities in each administrative unit, we calculated the total financial costs of these activities and the average cost per capita. The direct medical costs of hospitalized dengue cases in the public health sector were derived using operational budgets and a sample of bed head tickets of adult and pediatric patients available from six secondary-level hospitals. Results: In 2012, the total financial cost of dengue prevention and control activities in the Colombo District was about $998 000, or $0.43 per capita. The mean direct medical costs to the public health care system per case of hospitalized dengue fever (DF) and dengue haemoraggic fever (DHF) were $221 and $316 for paediatric partients, respectively, and $203 and $272 for adult patients, respectively. Conclusion: These preliminary results highlight the high economic burden of dengue to the public health sector in the Colombo district in Sri Lanka during an epidemic year and contribute to the sparse literature on the economic burden of dengue in affected countries. Acknowledgements: This research was funded by ‘DengueTools’ of the 7th Framework Programme of the European Community. Disclosure: Nothing to disclose.

Introduction: Dengue poses a significant socioeconomic and disease burden in Sri Lanka, where the geographic spread, incidence and severity of disease has been increasing since the first dengue hemorrhagic fever (DHF) epidemic occurred in 1989. Periodic epidemics have become progressively larger, peaking in 2012 with 44 456 cases. Passive surveillance was established nationwide more than a decade ago but dengue notifications have been based on clinical diagnosis, with infrequent laboratory confirmation. To obtain more accurate data on the disease burden, a laboratory-based enhanced sentinel surveillance system was established in Colombo Municipality, the area with the highest dengue incidence. Here we describe the study design and the results of the first 2 years (2012–2014). Methods: Three government hospitals and two outpatient clinics in Colombo District were selected for the sentinel surveillance. All patients presenting with undifferentiated fever were enrolled, if consent given, capped at a maximum of 60 patients per week. Acute blood samples were taken from all enrolled subjects and tested by dengue-specific PCR, and NS1, and IgM – ELISA at the time of first presentation. A sub-set of 536 samples was sent to Duke-NUS Singapore for quality assurance, virus isolation and serotyping. Results: Between 1 April, 2012 and 31 March, 2014, 3127 patients were enrolled, 964 (30.9%) as outpatients and 2160 (69.1%) as inpatients. The mean age was 22.3 years (SD = 17.5) and the time of first presentation was at day 4 of illness. For inpatients, 1687 (78.1%) of all febrile cases had laboratory-confirmed dengue. For outpatients, the proportion of confirmed dengue was 237 (24.6%). The mean duration of hospitalization was 4.1 days (SD = 1.85). The proportion of DHF in lab-confirmed hospitalized dengue cases was 22.1% and 4 patients (0.21%) died. Serotypes 1 and 4 were the only viruses detected in this sample (serotype 1: 85%; serotype 4: 15%). The clinicians’ diagnosis for dengue at time

Introduction: Dengue is a major acute febrile illness in Sri Lanka and reported in epidemic proportions. From 2009 to 2013 an average of 35 000 cases were reported annually with over 60% above 15 years of age. Clinical case classification of dengue was originally based on paediatric patients. Here we assess severity of dengue illness among adults according to both WHO classical and TDR classifications. Methods: A study was conducted in 100 adult patients presenting to ID Hospital, Colombo with fever <7 days, in 2013. All were tested for dengue ELISA NS1/IgM and RT-PCR. Of them 88 were confirmed as having dengue, and were classified into two WHO classifications. Type of care received was categorized into three levels as: Category 1 – general ward, Category 2 – special dengue unit, Category 3 – intensive care unit. Results: According to classical classification, 47 (53.4%) were Dengue Fever (DF) patients. Of them 31and 16 received Category 1 and 2 care respectively. None received Category 3 care. 41 (46.6%) Dengue Haemorrhagic Fever (DHF) patients. Of them 14 received category 1 care while 25 and two received Category 2 and Category 3 care respectively. Classical classification and level of care sensitivity was 62.8% (CI 48–78) while specificity was 68.9% (CI 55–82). According to TDR classification 29 (32.9%) were Dengue patients without warning signs. Of them 22 and 07 received Category 1 and 2 level of care respectively and none went into category 3. 48 (55%) were Dengue with warning signs and 11 (13%) severe dengue patients. Of them 18 received Category 1 care while 39 and two received category 2 and category 3 care respectively. TDR classification and level of care sensitivity was 85.4% (CI 75–95) Specificity 55% (CI 39–70). Conclusions: WHO TDR classification captures more patients who need closer observation in Category 2 and three levels of care than classical classification. This may warrant additional hospital resources in developing country settings. Disclosure: This

Introduction: In Sri Lanka, the number of dengue cases has steadily increased in recent years. Prevention through disease and vector surveillance is an important strategy in dengue control. The aim of the study was to assess Aedes mosquito breeding sites and the prevention practices of community members in one heavily urbanized area of Colombo. Methods: A cross-sectional entomological survey was conducted from April to June 2013 in 1469 premises located in a sub-district of Colombo Municipality. Types of breeding sites and infestation with larvae or pupae were recorded and a questionnaire was administered to occupants to assess knowledge and practises concerning dengue vector control. Results: The surveyed premises included 1341 households (91%), 99 work or public sites and 11 schools. 126 premises were positive for Aedes larvae or pupae. 12 672 potential breeding sites susceptible to host larvae or pupae were recorded, of which 21% contained water. Among these, 6% were positive for larvae and 13% for pupae. For schools the percentage rose to 40% and 67%, respectively. The main productive breeding sites were: discarded items, water tanks, ornamental plants, ponds and flowerpots, and non-specified containers. The majority was located on outdoor ground areas. Compared to households, the odds ratio for non-household premises of being infested with larvae was 2.29 (P = 0.005, 95% CI: 1.278–4.129) and with pupae 5.76 (P < 0.001, 95% CI: 2.660–12.497). Occupants of 82% of the premises reported using preventive measures. The main practices were coverage of containers and elimination of mosquito-breeding places. 45% of schools and 19% of households took no preventive measures. There was a significant correlation between the occurrence of preventative measures taken and the type of premise involved (P = 0.002). Conclusion: Residential buildings had the lowest relative number of potential breeding sites, and household members reported a high use of vector control measures. Sc

Introduction: Sri Lanka has experienced confirmed dengue outbreaks since the 1960s although severe dengue disease (DHF/DSS) didn’t appear until 1989. Since then, cyclical outbreaks associated with severe disease have occurred throughout the island. The most recent epidemic began in 2009 with the apparent introduction of a new genotype of DENV-1. To better understand the mechanisms underlying the persistence of this ongoing epidemic, a longitudinal study was conducted in hospitals in the Colombo district from April 2012 to March 2014. In order to glean as much information as possible about the viral genetics from this large cohort, we developed a novel Next Generation Sequencing (NGS) platform that can function without any a priori knowledge of the target dengue genome. Methods: The principle problem encountered when employing NGS directly on patient samples is the high ratio of host to viral RNA. To compensate for this, we developed a hybridization-based enrichment strategy consisting of DENV-specific 120nt, biotinylated oligodeoxynucleotides to capture DENV genomic material from an NGS library prepared directly from patient sera. Results: The strategy developed here allowed us to enrich DENV genomic material over 5000 fold relative to unenriched material. Full genome data and phylogenetic analysis indicate that the DENV-1 are predominantly genotype 1 although a smaller number of genotype 5 isolates was also identified. Conclusion: The platform developed for this study has the inherent ability to capture all four serotypes of DENV and can significantly increase the virus to host RNA ratio. The principle driver of the current dengue epidemic in Sri Lanka is the same DENV-1 genotype that has been in circulation since 2009. This research was funded by the Singapore Infectious Disease Initiative (SIDI/2013/012) and the European Union 7th Framework Programme through ‘DengueTools’. (www.dengue-tools.net). Disclosure: Nothing to disclose.

We present new cross section results from a joint experimental and theoretical investigation into low-energy positron and electron scattering from two targets of biological interest, namely tetrahydrofuran and 3-hydroxy-tetrahydrofuran. We compare and discuss the total, elastic and inelastic cross sections for these species in the light of potential positron and electron-induced damage in biomolecular systems.

We present results of measurements and calculations of elastic electron scattering from 1,4-dioxane in the energy range of 0-1000 eV. Absolute differential and integral elastic cross sections have been measured using a crossed electron-molecule beam spectrometer and the relative flow technique, at four energies in the 10-30 eV range and for scattered electrons in the angular range 20°-129°. The measured cross sections are compared with results from R-matrix computations, at the static exchange plus polarization level, calculated at energies between 0-20 eV, and with calculations employing the independent atom model with the screening corrected additivity rule (IAM-SCAR). Those latter computations were conducted at energies between 1 and 1000 eV. Agreement between the measured and R-matrix cross sections was typically found to be good at all common energies, whereas agreement with IAM-SCAR was satisfactory only at 30 eV. To the best of our knowledge, the present results are the first absolute data to be published in the literature for this scattering system.

We present total, elastic, and inelastic cross sections for positron and electron scattering from tetrahydrofuran (THF) in the energy range between 1 and 5000 eV. Total cross sections (TCS), positronium formation cross sections, the summed inelastic integral cross sections (ICS) for electronic excitations and direct ionization, as well as elastic differential cross sections (DCS) at selected incident energies, have been measured for positron collisions with THF. The positron beam used to carry out these experiments had an energy resolution in the range 40-100 meV (full-width at half-maximum). We also present TCS results for positron and electron scattering from THF computed within the independent atom model using the screening corrected additivity rule approach. In addition, we calculated positron-impact elastic DCS and the sum over all inelastic ICS (except rotations and vibrations). While our integral and differential positron cross sections are the first of their kind, we compare our TCS with previous literature values for this species. We also provide a comparison between positron and electron-impact cross sections, in order to uncover any differences or similarities in the scattering dynamics with these two different projectiles. © 2013 American Institute of Physics.

We report on new measurements for elastic electron scattering from pyrazine. Absolute differential cross sections (DCSs) at seven discrete energies in the range 3-50 eV, and over the scattered electron angular range 10°-129°, were determined using a crossed electron-molecular beam spectrometer in conjunction with the well-established relative flow technique. Integral elastic cross sections were subsequently derived from those DCS data at each energy. Where possible comparison between the present results and those from sophisticated Schwinger multichannel and R-matrix computations is made, with generally quite good quantitative accord being found. Finally, in order to better study some of the rich resonance structure predicted by theory, results from elastic electron excitation functions are presented.