**Aim 1.** To perform febrile illness surveillance in southern Sri Lanka 1a. Determine the prevalence and seasonal distribution of diverse causes of dengue-like illnesses, in children and adults presenting to an acute care setting in Southern Sri Lanka. 1b. Determine the prevalence and seasonal distribution of diverse causes of febrile respiratory illnesses, including influenza (influenza-like illness), in children and adults presenting to an acute care setting in Southern Sri Lanka. 1c. Assess the clinical and epidemiological characteristics of the diverse etiologies of febrile respiratory illness in children and adults in Southern Sri Lanka. 1d. Validate a clinical predictor for common etiologies of febrile illness. **Aim 2.** Assess performance of novel pathogen and host-based diagnostics for acute febrile illness 2a. Implement a real-time multiplex respiratory viral PCR capacity at Ruhuna Microbiology 2b. Validate a real-time multiplex dengue-like illness PCR at Ruhuna Microbiology 2c. Validate a host-response signature for respiratory viral infection in a Sri Lanka population. 2d. Implement a pathogen discovery protocol to determine novel etiologies of severe acute respiratory illness in southern Sri Lanka **Aim 3.** To perform a geospatial analysis of etiologies of febrile illness in Southern Sri Lanka 3a. To determine the spatial prevalence of acute febrile illness due to acute respiratory infections, dengue, rickettsiae, leptospira, and bacterial infections, as well as undifferentiated acute febrile illness, in Galle district and visualize the results in digital maps at the sub-divisional level. 3b. To determine geospatial correlations between acute febrile illness and certain ecological (social or natural) features, respectively for all acute febrile illness, dengue, scrub typhus, leptospirosis, enteric fever, other viral infection, and undifferentiated acute febrile illness.

* Use of Rapid Influenza Testing to Reduce Antibiotic Prescriptions Among Outpatients with Influenza-Like Illness in Southern Sri Lanka. Tillekeratne LG, Bodinayake CK, Nagahawatte A, Vidanagama D, Devasiri V, Arachchi WK, Kurukulasooriya R, De Silva AD, Østbye T, Reller ME, Woods CW. Am J Trop Med Hyg. 2015 Nov 4;93(5):1031-7. doi: 10.4269/ajtmh.15-0269. Epub 2015 Aug 17. PMID: 26283748 * An under-recognized influenza epidemic identified by rapid influenza testing, southern Sri Lanka, 2013. Tillekeratne LG, Bodinayake CK, Nagahawatte A, Vidanagama D, Devasiri V, Arachchi WK, Kurukulasooriya R, De Silva AD, Østybe T, Reller ME, Woods CW. Am J Trop Med Hyg. 2015 May;92(5):1023-9. doi: 10.4269/ajtmh.14-0708. Epub 2015 Mar 2. PMID: 25732679 * Chikungunya as a cause of acute febrile illness in southern Sri Lanka. Reller ME, Akoroda U, Nagahawatte A, Devasiri V, Kodikaarachchi W, Strouse JJ, Chua R, Hou Y, Chow A, Sessions OM, Østbye T, Gubler DJ, Woods CW, Bodinayake C. PLoS One. 2013 Dec 2;8(12):e82259. doi: 10.1371/journal.pone.0082259. eCollection 2013. PMID: 24312651 * Unsuspected rickettsioses among patients with acute febrile illness, Sri Lanka, 2007. Reller ME, Bodinayake C, Nagahawatte A, Devasiri V, Kodikara-Arachichi W, Strouse JJ, Flom JE, Østbye T, Woods CW, Dumler JS. Emerg Infect Dis. 2012 May;18(5):825-9. doi: 10.3201/eid1805.111563. PMID: 22516455 * Unsuspected dengue and acute febrile illness in rural and semi-urban southern Sri Lanka. Reller ME, Bodinayake C, Nagahawatte A, Devasiri V, Kodikara-Arachichi W, Strouse JJ, Broadwater A, Østbye T, de Silva A, Woods CW. Emerg Infect Dis. 2012 Feb;18(2):256-63. doi: 10.3201/eid1802.110962. PMID: 22304972 * Leptospirosis as frequent cause of acute febrile illness in southern Sri Lanka. Reller ME, Bodinayake C, Nagahawatte A, Devasiri V, Kodikara-Arachichi W, Strouse JJ, Flom JE, Dumler JS, Woods CW. Emerg Infect Dis. 2011 Sep;17(9):1678-84. doi: 10.3201/eid1709.100915. PMID: 21888794 * The impact of the Tsunami on hospitalizations at the tertiary care hospital in the Southern Province of Sri Lanka. Ostbye T, Ponnamperuma T, Fernando N, Abeygunawardena V, Wijayasiri WA, Chen JJ, Woods CW. Am J Disaster Med. 2008 May-Jun;3(3):147-55. PMID: 18666511

Reduce inappropriate antibiotic use and emergence of antimicrobial resistance