State of affairs at a look
Between 1 January and 27 September 2022, a complete of 25 932 confirmed dengue circumstances and 62 deaths (CFR 0.25%) have been reported in Pakistan, with 74% of those circumstances reported within the month of September alone. The present surge in circumstances follows unprecedented flooding that started in mid-June 2022. With the present flood disaster affecting the nationwide well being system capability and the rising humanitarian scenario, there’s a excessive threat of significant well being impacts from dengue fever and different concurrent illness outbreaks. Excessive inhabitants motion between Pakistan and bordering nations (particularly, Afghanistan and the Islamic Republic of Iran) signifies that the worldwide transmission of dengue fever can’t be dominated out.
Description of the outbreak
Dengue fever is endemic to Pakistan, which experiences year-round transmission with seasonal peaks. Nonetheless, triggered by the worst flooding within the nation’s historical past that started in mid-June, the variety of reported dengue circumstances is considerably larger in 2022 (between January and September) as in comparison with the identical interval through the 4 earlier years.
Between 1 January to 27 September 2022, in accordance with the Nationwide Institute of Well being-Islamabad, a cumulative complete of 25 932 confirmed dengue circumstances and 62 deaths have been reported nationally. Three-quarters (74%) of those circumstances have been reported through the month of September alone. As of twenty-two September, the distribution of circumstances by province was out there for 83% (n=21 777) of the full circumstances, of which 32% (n=6888) have been reported from Sindh, 29% (n=6255) from Punjab (together with the Islamabad Capital Territory), 25% (n=5506) from Khyber Pakhtunkhwa, and 14% (n=3128) from Balochistan (Determine 1).
Determine 1. Distribution of confirmed dengue circumstances in Pakistan by province, 1 January to 22 September 2022.Epidemiology of dengue
Dengue is a viral an infection transmitted by mosquitoes brought on by 4 forms of dengue virus (DENV 1, DENV 2, DENV 3, DENV 4). An infection with one serotype offers long-term immunity to the homologous serotype, however to not different serotypes; sequential infections put individuals at higher threat of extreme dengue. DENV may cause an acute flu-like sickness, many DENV infections produce solely delicate sickness; over 80% of circumstances are asymptomatic.
There isn’t a particular therapy for dengue, nonetheless, well timed detection of circumstances, figuring out any warning indicators of extreme dengue an infection, and acceptable case administration are key parts of care to stop affected person loss of life and may decrease fatality charges of extreme an infection to beneath 1%.
Dengue fever is endemic in Pakistan, with seasonal outbreaks and the circulation of the 4 serotypes in numerous areas of the nation. Aedes aegypti and Aedes albopictus are broadly tailored vectors for city and peri-urban environments. As dengue is recurrent within the nation, the inhabitants could also be vulnerable to re-infection and due to this fact, critical issues might happen if not managed promptly and appropriately.
Public well being response
The Ministry of Well being, in collaboration with the World Fund, is conducting vector surveillance and management actions as part of Built-in Vector Administration, together with:
- Technical weekly committee conferences chaired by the Ministry of Well being.
- Activation of ‘dengue counters’ in all well being services; designated areas in emergency departments allotted for receiving suspected dengue circumstances.
- Enhancement of vector surveillance actions in Lahore and different districts.
- Provision of further groups to assist vector surveillance actions together with the day by day scenario evaluation.
The WHO is offering assist together with:
- Coordination at a number of high-level conferences for well being authorities together with visits and conferences of the WHO consultant.
- Strengthening of laboratory and hospital-based illness surveillance throughout all provinces within the nation has been initiated.
- Coaching of chosen well being care suppliers from all provinces within the nation is being held on case administration of dengue fever.
- Coaching on vector surveillance and vector management together with supply discount throughout home visits is underway.
- Provision of 230 000 speedy diagnostic checks (RDTs) for dengue and different ailments, together with malaria, acute watery diarrhoea, chikungunya, hepatitis A and E.
WHO threat evaluation
Pakistan is experiencing an irregular monsoon rainfall and unprecedented floods. One-third of the nation and an estimated 33 million individuals have been impacted in 84 calamity declared districts. Greater than 2 million homes have been destroyed and an estimated 1460 well being services have additionally reportedly been broken. Some 7.9 million individuals are reportedly displaced, 12 900 individuals injured, and 1600 individuals have died. Heavy rains and floods have left hundreds of thousands of individuals with out entry to healthcare and medical therapy.
With the present flood disaster affecting the nationwide well being system capability, there’s a excessive threat of significant well being impacts from dengue fever. At present, there’s a want for improved vector surveillance, enhanced laboratory capability for higher detection, sensitization of well being care suppliers on case administration (together with warning indicators of extreme dengue) and improved surveillance of acute febrile sickness to higher outline illness burden and seasonality patterns.
Vector-borne epidemics – together with dengue – after flooding is a widely known phenomenon, because the stagnant water offers favorable habitats for mosquitoes to breed. The lag time is normally round 3-4 weeks earlier than the incidence of dengue circumstances.
Ongoing illness outbreaks in Pakistan, together with acute watery diarrhoea, dengue, malaria, measles, polio, and COVID-19 are being additional aggravated, significantly in internally displaced individuals and refugee camps and the place water and sanitation services have been broken.
Dengue fever is essentially the most quickly spreading mosquito-borne virus an infection on the planet. There may be excessive inhabitants motion between Pakistan—particularly, Khyber Pakhtunkhwa province— and bordering nations, particularly the Islamic Republic of Iran and Afghanistan. Khyber Pakhtunkhwa province can be dwelling to 1 200 000 Afghani refugees, of which 800 000 reside in districts formally notified as calamity hit by floods. The transmission of dengue fever from Pakistan to frame nations can’t be dominated out.
The proximity of mosquito vector breeding websites to human habitation is a major threat issue for dengue virus an infection. There isn’t a particular therapy for dengue an infection, however early detection and entry to acceptable healthcare scale back mortality. Moreover, the prevention and management of dengue rely upon efficient vector surveillance and management.
WHO promotes the strategic strategy referred to as Built-in Vector Administration (IVM) to manage mosquito exercise and inhabitants, together with Aedes spp. (the vector of dengue).
IVM actions must be enhanced to take away potential breeding websites, scale back vector populations, and reduce particular person publicity. This could contain vector management methods for larvae and adults (i.e. environmental administration and supply discount, and chemical management measures), in addition to methods for shielding individuals and households. Vector management actions ought to give attention to all areas the place there’s human-vector contact (place of residence, workplaces, faculties and hospitals).
Vector management actions can embrace protecting, draining and cleansing family water storage containers on a weekly foundation. As well as, this may increasingly embrace chlorination of ingesting water and software of appropriate larvicides/pesticides for water storage in outside containers.
The place indoor biting happens, software of mosquito repellent lotion or sprays on the pores and skin, use of family insecticide aerosol merchandise, mosquito coils, or different insecticide vaporizers are beneficial. Family fixtures corresponding to window and door screens and air-con also can scale back bites. Since Aedes spp mosquitoes (the first vector for transmission) are day biters with peak exercise at daybreak and nightfall, private protecting measures corresponding to the use of clothes to attenuate pores and skin publicity are beneficial. Throughout outside actions, mosquito repellents could also be utilized to uncovered pores and skin or to clothes. Insecticide-treated nets supply good safety to individuals who sleep outdoors or through the day (e.g. infants, individuals confined to mattress, and evening employees) and at evening to stop mosquito bites.
As well as, vector and human case surveillance ought to proceed to be enhanced in all affected areas and throughout the nation. Key public well being messages on decreasing the chance of dengue transmission among the many inhabitants are anticipated to proceed to be offered.
WHO doesn’t advocate any basic journey or commerce restrictions to Pakistan based mostly on the knowledge out there for this occasion.