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Riaz M, Harun SNB, Mallhi TH, Khan YH, Butt MH, Husain A, Khan MM, Khan AH. Evaluation of clinical and laboratory characteristics of dengue viral infection and risk factors of dengue hemorrhagic fever: a multi-center retrospective analysis. BMC Infect Dis 2024; 24:500. [PMID: 38760732 PMCID: PMC11102246 DOI: 10.1186/s12879-024-09384-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 05/07/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Dengue Viral Infection (DVI) has become endemic in Pakistan since the first major outbreak in Karachi in 1996. Despite aggressive measures taken by relevant authorities, Pakistan has been dealing with a worsening dengue crisis for the past two decades. DHF is severe form of dengue infection which is linked with significant morbidity and mortality. Early identification of severe dengue infections can reduce the morbidity and mortality. In this context we planned current study in which we find out the different factors related with DHF as well as clinical laboratory features of DHF and compare them to DF so that patients can be best evaluated for DHF and managed accordingly at admission. METHODS Retrospective study conducted over a period of 6 years (2013-2018) in two tertiary care hospitals in Pakistan. Data were collected by using a pre-structured data collection form. Data were statistically analyzed to determine the clinical and laboratory characteristics of DVI and risk factors of dengue hemorrhagic fever (DHF). RESULTS A total 512 dengue cases (34.05 ± 15.08 years; Male 69.53%) were reviewed. Most common clinical manifestations of DVI were fever (99.60%), headache (89.1%), chills (86.5%), rigors (86.5%), myalgia (72.3%). Less common clinical manifestations were vomiting (52.5%), arthralgia (50.2%) and skin rashes (47.5%). Furthermore, nasal bleeding (44.1%), gum bleeding (32.6%), pleural effusion (13.9%) and hematuria (13.1%) were more profound clinical presentations among DHF patients. Mortality rate was 1.5% in this study. Logistic regression analysis indicated that delayed hospitalization (OR: 2.30) and diabetes mellitus (OR:2.71), shortness of breath (OR:2.21), association with risk groups i.e., living near stagnant water, travelling to endemic areas, living in endemic regions (OR:1.95), and presence of warning signs (OR:2.18) were identified as risk factors of DHF. Statistically we found that there is strong association of diabetes mellitus (DM) with DHF while the patient suffering from DM individually had higher odds (2.71) of developing DHF than patients without disease. CONCLUSIONS The current study demonstrated that the clinical and laboratory profiles of DF and DHF are significantly distinct. Significant predictors of DHF were advanced age, diabetes mellitus, ascites, pleural effusion, thick gallbladder and delayed hospitalization. The identification of these factors at early stage provides opportunities for the clinicians to identify high risk patients and to reduce dengue-related morbidity and mortality.
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Affiliation(s)
- Muhammad Riaz
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Palau Penang, Malaysia
- Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Faisalabad, Pakistan
| | - Sabriah Noor Binti Harun
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Palau Penang, Malaysia
| | - Tauqeer Hussain Mallhi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakakah, Al-Jouf, Kingdom of Saudi Arabia
| | - Yusra Habib Khan
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakakah, Al-Jouf, Kingdom of Saudi Arabia
| | - Muhammad Hammad Butt
- Department of Medicinal Chemistry, Faculty of Pharmacy, Uppsala University, Uppsala, 75123, Sweden.
| | - Aamir Husain
- Department of Medicine, Faisalabad Medical University, Faisalabad, Pakistan
| | - Muhammad Mujeeb Khan
- Department of Infectious Diseases, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Palau Penang, Malaysia
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Zohra T, Din M, Ikram A, Bashir A, Jahangir H, Baloch IS, Irshad S, Waris A, Salman M, Iqtadar S, Ayaz M. Demographic and clinical features of dengue fever infection in Pakistan: a cross-sectional epidemiological study. Trop Dis Travel Med Vaccines 2024; 10:11. [PMID: 38581059 PMCID: PMC10998367 DOI: 10.1186/s40794-024-00221-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/26/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Dengue fever caused by dengue virus is a tropical disease and is among the deadliest vector-borne diseases. The humid and hot summers of Pakistan support the probation of the vectors responsible for the transmission of viral and other parasitic diseases. METHODOLOGY A retrospective study, from 2012- 2019, of dengue infected individuals from the Punjab province of Pakistan was carried out to analyze epidemiology, clinical and laboratory findings of subjects with dengue virus infection. Data was derived from National Institute of Health (NIH) followed by Dengue control program of Pakistan, covering the incidence rate in 36 districts of Punjab and Islamabad Capital Territory (ICT) respectively. Patients data including the presence of dengue specific antigen or/and antibodies such as NS1 and IgG/IgM were observed. The study also included the analysis of demographic data, geographic data, and the month-wise distribution of dengue cases to examine seasonal trends. RESULTS We analyzed 25,682 dengue infected individuals. The statistical analysis revealed a significant association between genders in which male population was more affected by dengue than females. It was also noted that the middle age group was the most affected age group while the highest number of cases were reported in October. Rawalpindi and Lahore were the most affected cities in Punjab province while Islamabad represented the highest number of cases during the recent outbreak in 2019. The IgM and IgG antibodies were highly prevalent among the infected patients. CONCLUSION Dengue is endemic in Pakistan, circulating throughout the year. Highest number of cases were observed in the month of October, September and November respectively. Association between climate change and vector-borne diseases need to be investigated in Pakistan as they significantly influence the timing and intensity of dengue and other disease outbreaks. Further exploration of hematological parameters is required to better diagnose and treat the disease. For the effective control of dengue outbreaks, awareness campaigns on sewage management and vector control along with social factors are strongly recommended for better control and eradication of the disease.
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Affiliation(s)
- Tanzeel Zohra
- National Institutes of Health, Islamabad, 45500, Pakistan.
| | - Misbahud Din
- Quaid-I-Azam University, Islamabad, 45320, Pakistan
| | - Aamer Ikram
- National Institutes of Health, Islamabad, 45500, Pakistan
| | - Adnan Bashir
- Health Information Systems Program, Islamabad, Pakistan
| | - Haroon Jahangir
- Primary and Secondary Healthcare Department, Government of Punjab, Lahore, Pakistan
| | | | - Sundas Irshad
- Primary and Secondary Healthcare Department, Government of Punjab, Lahore, Pakistan
| | - Abdul Waris
- Quaid-I-Azam University, Islamabad, 45320, Pakistan
| | | | - Somia Iqtadar
- Dengue Expert Advisory Group Punjab, King Edward Medical University, Lahore, 54000, Pakistan
| | - Muhammad Ayaz
- Department of Pharmacy, University of Malakand Khyber, Chakdara, 18800, Pakistan.
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Shrestha DB, Budhathoki P, Gurung B, Subedi S, Aryal S, Basukala A, Aryal B, Adhikari A, Poudel A, Yadav GK, Khoury M, Rayamajhee B, Shrestha LB. Epidemiology of dengue in SAARC territory: a systematic review and meta-analysis. Parasit Vectors 2022; 15:389. [PMID: 36280877 PMCID: PMC9594905 DOI: 10.1186/s13071-022-05409-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/13/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Dengue is one of the common arboviral infections and is a public health problem in South East Asia. The aim of this systematic review and meta-analysis was to evaluate the prevalence and distribution of dengue in SAARC (South Asian Association for Regional Cooperation) countries. METHODS The PubMed, PubMed Central, Embase and Scopus databases were searched for relevant studies. Statistical analysis on data extracted from the selected studied was conducted using the Comprehensive Meta-Analysis Software (CMA) version 3 software package. Proportions were used to estimate the outcome with a 95% confidence interval (CI). RESULTS Across all studies, among cases of suspected dengue, 30.7% were confirmed dengue cases (proportion: 0.307, 95% CI: 0.277-0.339). The seroprevalence of dengue immunoglobulin (Ig)G, IgM or both (IgM and IgG) antibodies and dengue NS1 antigen was 34.6, 34.2, 29.0 and 24.1%, respectively. Among the different strains of dengue, dengue virus (DENV) strains DENV-1, DENV-2, DENV-3 and DENV-4 accounted for 21.8, 41.2, 14.7 and 6.3% of cases, respectively. The prevalence of dengue fever, dengue hemorrhagic fever and dengue shock syndrome was 80.5, 18.2 and 1.5%, respectively. Fever was a commonly reported symptom, and thrombocytopenia was present in 44.7% of cases. Mortality was reported in 1.9% of dengue cases. CONCLUSIONS Dengue is a common health problem in South East Asia with high seroprevalence. DENV-2 was found to be the most common strain causing infection, and most dengue cases were dengue fever. In addition, thrombocytopenia was reported in almost half of the dengue cases.
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Affiliation(s)
| | | | | | | | | | - Anisha Basukala
- Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Barun Aryal
- Department of Emergency Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Anurag Adhikari
- Department of Emergency Medicine, Nepal National Hospital, Kathmandu, Nepal
| | - Ayusha Poudel
- Department of Emergency Medicine, Alka Hospital, Kathmandu, Nepal
| | | | - Mtanis Khoury
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL USA
| | - Binod Rayamajhee
- School of Optometry & Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Department of Infection and Immunology, Kathmandu Research Institute for Biological Sciences (KRIBS), Lalitpur, Nepal
| | - Lok Bahadur Shrestha
- Department of Microbiology & Infectious Diseases, B. P. Koirala Institute of Health Sciences, Dharan, 56700 Nepal
- School of Medical Sciences and the Kirby Institute, University of New South Wales, Sydney, Australia
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Khan J, Adil M, Wang G, Tsheten T, Zhang D, Pan W, Khan MA, Rehman IU, Zheng X, Wu Z, Wu Y. A cross-sectional study to assess the epidemiological situation and associated risk factors of dengue fever; knowledge, attitudes, and practices about dengue prevention in Khyber Pakhtunkhwa Province, Pakistan. Front Public Health 2022; 10:923277. [PMID: 35968472 PMCID: PMC9372552 DOI: 10.3389/fpubh.2022.923277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022] Open
Abstract
Background Dengue fever has been responsible for around 12 countrywide large outbreaks in Pakistan, resulting in 286,262 morbidities and 1,108 deaths. Khyber Pakhtunkhwa (KP) is the most recently impacted province. This study aimed to investigate the molecular, epidemiological, and potential elements that contribute to increasing dengue transmission patterns, and knowledge, attitude, and practice (KAP) toward dengue in KP province. Method This cross-sectional community-based study was conducted (June-December, 2021) in two phases. Phase I involved the epidemiological (n = 5,242) and molecular analysis of DENV in 500 randomly collected blood samples of the 2021 dengue outbreak in KP. Phase II focused on assessing dengue-KAP levels in healthy communities (n = 14,745, aged >18 years), adopting a cross-sectional clustered multistage sampling in eight districts (dengue-hotspot vs. non-hotspot) of KP. Chi-square tests and logistic regression analysis were applied. Results Peshawar district had the highest dengue cases (60.0%) associated with the predominant co-circulation of DENV-2 (45.8%) and DENV-3 (50.4%) serotypes. A rise in cases was reported in October (41.8%) followed by September (27.9%) and August (14.4%; p < 0.001). Males (63.7%, p < 0.001) and individuals aged 16–30 years (37.0%, p < 0.001) were highly affected. General workers (18.0%), families with a monthly income of 10,000–20,000 Pak rupees (50.5%), unmarried (71.0%), uneducated (31%), families with higher human density (>10 individuals per household), and those (29.0%) who faced power outages for more than 7/24 h were the most affected. Moreover, co-morbidities like renal failure and bronchial asthma were associated with disease severity. A community survey on KAP revealed that an average of 74, 60, and 43% of the participants demonstrated good knowledge, attitudes, and dengue preventive practices, respectively. Conclusion Multiple poor socioeconomic elements are influencing dengue fever transmission in the province. Higher KAP levels may explain the low frequency of dengue in non-hotspot districts. Our study emphasizes the need for effective and long-term public health education, strengthened vector surveillance, and expanded laboratory capacity for better diagnosis and management of dengue cases to better predict the burden and seasonality of disease in the country.
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Affiliation(s)
- Jehangir Khan
- Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Tropical Disease Control of the Ministry of Education, Sun Yat-sen University-Michigan State University Joint Center of Vector Control for Tropical Disease, Zhongshan School of Medicine, Guangzhou, China
- Chinese Atomic Energy Agency Center of Excellence on Nuclear Technology Applications for Insect Control, Sun Yat-sen University, Guangzhou, China
- Department of Zoology, Abdul Wali Khan University Mardan, Mardan, Pakistan
| | | | - Gang Wang
- Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Tropical Disease Control of the Ministry of Education, Sun Yat-sen University-Michigan State University Joint Center of Vector Control for Tropical Disease, Zhongshan School of Medicine, Guangzhou, China
- Chinese Atomic Energy Agency Center of Excellence on Nuclear Technology Applications for Insect Control, Sun Yat-sen University, Guangzhou, China
| | - Tsheten Tsheten
- Department of Global Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
- Royal Centre for Disease Control, Ministry of Health, Thimphu, Bhutan
| | - Dongjing Zhang
- Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Tropical Disease Control of the Ministry of Education, Sun Yat-sen University-Michigan State University Joint Center of Vector Control for Tropical Disease, Zhongshan School of Medicine, Guangzhou, China
- Chinese Atomic Energy Agency Center of Excellence on Nuclear Technology Applications for Insect Control, Sun Yat-sen University, Guangzhou, China
| | - Wenjie Pan
- Guangzhou SYSU Nuclear and Insect Biotechnology Co., Ltd., Guangzhou, China
| | - Munir Ahmad Khan
- Medical Unit, Khyber Teaching Hospital Peshawar, Peshawar, Pakistan
| | - Inayat ur Rehman
- Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan, Pakistan
| | - Xiaoying Zheng
- Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Tropical Disease Control of the Ministry of Education, Sun Yat-sen University-Michigan State University Joint Center of Vector Control for Tropical Disease, Zhongshan School of Medicine, Guangzhou, China
- Chinese Atomic Energy Agency Center of Excellence on Nuclear Technology Applications for Insect Control, Sun Yat-sen University, Guangzhou, China
| | - Zhongdao Wu
- Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Tropical Disease Control of the Ministry of Education, Sun Yat-sen University-Michigan State University Joint Center of Vector Control for Tropical Disease, Zhongshan School of Medicine, Guangzhou, China
- Chinese Atomic Energy Agency Center of Excellence on Nuclear Technology Applications for Insect Control, Sun Yat-sen University, Guangzhou, China
- Department of Global Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
- *Correspondence: Zhongdao Wu
| | - Yu Wu
- Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Tropical Disease Control of the Ministry of Education, Sun Yat-sen University-Michigan State University Joint Center of Vector Control for Tropical Disease, Zhongshan School of Medicine, Guangzhou, China
- Chinese Atomic Energy Agency Center of Excellence on Nuclear Technology Applications for Insect Control, Sun Yat-sen University, Guangzhou, China
- Yu Wu
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Anwar F, Ullah S, Aziz AUR, Rehman AU, Khan J, Tayyab M, Haq I, Mahmood MT. Epidemiological and hematological investigation of Dengue Virus infection. Microbiol Immunol 2022; 66:426-432. [PMID: 35769047 DOI: 10.1111/1348-0421.13018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/21/2022] [Accepted: 06/27/2022] [Indexed: 11/29/2022]
Abstract
Dengue is a mosquito-borne viral illness that infects humans. For the last few decades, it has been declared a global public health problem. The current study was conducted at the district headquarter hospital (DHQ) Bannu between June to September 2018 based on the seroprevalence of antibodies against dengue virus serotypes and their hematological parameters among the patients. A total of 1738 suspected individuals were diagnosed through NS1, IgG, and IgM antibodies and RT-PCR techniques. Out of all the samples, 716 (41.19%) were found to be positive for dengue. A higher infection rate was found in males (65.92%) as compared to females (34.07%). The most affected age group was 16-40 years, whereas the most affected tehsil was Bannu, where the DENV-3 serotype was prevalent. The rare serotype (DENV-4) was found in 1% of cases. Symptoms including fever (100%), myalgia (100%), headache (61.31%), vomiting (34.63%), and rashes were common among the dengue patients. However, the mild cases showed fewer clinical signs compared to the severe infected cases. The study also revealed a significant association (P<0.05) between hematological parameters and dengue infection, showing a significant decrease in TC, eosinophils, neutrophils, and platelets and a significant increase in monocytes and lymphocytes. Based on the current report, it is concluded that patients with the above symptoms and hematological changes may have increased probability of Dengue and should be kept under observation to separate dengue positive patients and enhance treatment process. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Faheem Anwar
- Department of Biotechnology and Genetic Engineering, Hazara University, Mansehra, 21300, KP, Pakistan
| | - Sami Ullah
- Department of Biotechnology and Genetic Engineering, Hazara University, Mansehra, 21300, KP, Pakistan
| | - Aziz Ur Rehman Aziz
- School of Biomedical Engineering, Dalian university of Technology, Dalian, China
| | - Abid Ur Rehman
- Department of Biotechnology and Genetic Engineering, Hazara University, Mansehra, 21300, KP, Pakistan
| | - Jawad Khan
- Department of Biotechnology and Genetic Engineering, Hazara University, Mansehra, 21300, KP, Pakistan
| | - Muhammad Tayyab
- Institute of Biotechnology and Genetic Engineering, The University of Agriculture, Peshawar, KP, Pakistan
| | - Ihteshamul Haq
- Department of Biotechnology and Genetic Engineering, Hazara University, Mansehra, 21300, KP, Pakistan
| | - Muhammad Tariq Mahmood
- Department of Zoology, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
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Yasmeen N, Jabbar A, Shah T, Fang LX, Aslam B, Naseeb I, Shakeel F, Ahmad HI, Baloch Z, Liu Y. One Health Paradigm to Confront Zoonotic Health Threats: A Pakistan Prospective. Front Microbiol 2022; 12:719334. [PMID: 35211097 PMCID: PMC8861076 DOI: 10.3389/fmicb.2021.719334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 12/21/2021] [Indexed: 12/26/2022] Open
Abstract
The emergence and re-emergence of zoonotic diseases significantly impact human health, particularly those who live in impoverished areas and have close contact with domestic or wild animals. Nearly 75% of zoonotic diseases are transmitted directly from animals to humans or indirectly via vector/agent interactions between animals and humans. Growing populations, globalization, urbanization, and the interaction of the environment with humans and livestock all play roles in the emergence and spread of zoonotic diseases. "One Health" is a multidisciplinary concept aimed at improving human, animal, and environmental health, but this concept is not widely accepted in developing countries. In Pakistan, environmental, human, and animal health are severely affected due to a lack of sufficient resources. This review article provides an overview of the most common zoonotic diseases found in Pakistan and emphasizes the importance of the "One Health" concept in managing these diseases. Given the current situation, interdisciplinary research efforts are required to implement and sustain effective and long-term control measures in animal, human, and environmental health surveillance and accurate diagnostic methods.
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Affiliation(s)
- Nafeesa Yasmeen
- National Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original Bacteria, South China Agricultural University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Veterinary Pharmaceutics Development and Safety Evaluation, South China Agricultural University, Guangzhou, China
| | - Abdul Jabbar
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China
| | - Taif Shah
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China
| | - Liang-xing Fang
- National Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original Bacteria, South China Agricultural University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Veterinary Pharmaceutics Development and Safety Evaluation, South China Agricultural University, Guangzhou, China
| | - Bilal Aslam
- Department of Microbiology, Government College University, Faisalabad, Pakistan
| | - Iqra Naseeb
- Institute of Applied Microbiology, University of Veterinary and Animal Sciences, Punjab, Pakistan
| | - Faiqa Shakeel
- Institute of Applied Microbiology, University of Veterinary and Animal Sciences, Punjab, Pakistan
| | - Hafiz Ishfaq Ahmad
- Department of Animal Breeding and Genetics, University of Veterinary and Animal Sciences, Punjab, Pakistan
| | - Zulqarnain Baloch
- Guangdong Provincial Key Laboratory of Veterinary Pharmaceutics Development and Safety Evaluation, South China Agricultural University, Guangzhou, China
| | - Yahong Liu
- National Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original Bacteria, South China Agricultural University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Veterinary Pharmaceutics Development and Safety Evaluation, South China Agricultural University, Guangzhou, China
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Shafique M, Mukhtar M, Areesantichai C, Perngparn U. Effectiveness of Positive Deviance, an Asset-Based Behavior Change Approach, to Improve Knowledge, Attitudes, and Practices Regarding Dengue in Low-Income Communities (Slums) of Islamabad, Pakistan: A Mixed-Method Study. INSECTS 2022; 13:insects13010071. [PMID: 35055914 PMCID: PMC8780378 DOI: 10.3390/insects13010071] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/31/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022]
Abstract
Simple Summary Dengue is a mosquito-borne infection caused by the Aedes mosquito, expanding at an alarming pace around the world. Recently, Pakistan has witnessed some major dengue outbreaks, affecting thousands of individuals across the country. As there is no specific cure or vaccine, prevention and vector control remain the key methods to avoid dengue infection. In Pakistan, dengue control activities are mainly focused on information-sharing through mass media and communication materials such as pamphlets and posters. The main challenge is a lack of community participation that can create an enabling environment for communities to follow the desired behaviors. There is a strong need to design and implement community-led behavior change approaches to ensure community participation and translate the knowledge into practices. This study was conducted to better understand the effectiveness of a community engagement approach, ‘positive deviance’, on dengue prevention and control. The study was carried out in two slums affected by the recent dengue outbreak in Islamabad, Pakistan. A total of 112 persons participated in the study, which was conducted from June–October 2020. The community discovered already-existing positive behaviors surrounding dengue prevention and control, which were shared with other participants through interactive activities. The study demonstrated positive changes in knowledge, attitudes, and practices, and could be a potential tool for dengue prevention and control programs worldwide. Abstract Dengue is a mosquito-borne, viral disease that has emerged as a global health concern in recent years. In the absence of specific antiviral treatment and vaccines, prevention remains the key strategy for dengue control. Therefore, innovative and community-driven approaches are required to improve the vector control practices. This study applied and evaluated the positive deviance (PD) approach on dengue prevention and control in selected slums of Islamabad during June–October 2020. The two most dengue-affected slums, the Faisal colony and France colony, were purposively selected as intervention and control groups, respectively. A total of 112 participants (56 for the intervention and 56 for the control group) participated in the study. The intervention group was exposed for two months to locally identified role model behaviors through weekly interactive sessions, dengue sketch competitions, and role plays. Another two months enabled the community to practice these behaviors without any external support in order to explore the intervention’s sustainability. Three surveys were conducted: before the intervention, after two months, and after four months, to assess any changes in the knowledge, attitudes, and practices of participating communities. Results found that the PD intervention had a significant positive impact on dengue knowledge, attitudes, and practices in the intervention group. PD could offer an empowering and efficient community engagement tool for future dengue prevention and control, both in Pakistan and more globally.
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Affiliation(s)
- Muhammad Shafique
- College of Public Health Sciences, Chulalongkorn University, Bangkok 10330, Thailand; (M.S.); (C.A.)
| | | | - Chitlada Areesantichai
- College of Public Health Sciences, Chulalongkorn University, Bangkok 10330, Thailand; (M.S.); (C.A.)
- Health and Social Science and Addiction Research Unit (HSSRU), Bangkok 10330, Thailand
| | - Usaneya Perngparn
- College of Public Health Sciences, Chulalongkorn University, Bangkok 10330, Thailand; (M.S.); (C.A.)
- Correspondence:
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Integrating Spatial Modelling and Space-Time Pattern Mining Analytics for Vector Disease-Related Health Perspectives: A Case of Dengue Fever in Pakistan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212018. [PMID: 34831785 PMCID: PMC8618682 DOI: 10.3390/ijerph182212018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/31/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022]
Abstract
The spatial–temporal assessment of vector diseases is imperative to design effective action plans and establish preventive strategies. Therefore, such assessments have potential public health planning-related implications. In this context, we here propose an integrated spatial disease evaluation (I-SpaDE) framework. The I-SpaDE integrates various techniques such as the Kernel Density Estimation, the Optimized Hot Spot Analysis, space–time assessment and prediction, and the Geographically Weighted Regression (GWR). It makes it possible to systematically assess the disease concentrations, patterns/trends, clustering, prediction dynamics, and spatially varying relationships between disease and different associated factors. To demonstrate the applicability and effectiveness of the I-SpaDE, we apply it in the second largest city of Pakistan, namely Lahore, using Dengue Fever (DF) during 2007–2016 as an example vector disease. The most significant clustering is evident during the years 2007–2008, 2010–2011, 2013, and 2016. Mostly, the clusters are found within the city’s central functional area. The prediction analysis shows an inclination of DF distribution from less to more urbanized areas. The results from the GWR show that among various socio-ecological factors, the temperature is the most significantly associated with the DF followed by vegetation and built-up area. While the results are important to understand the DF situation in the study area and have useful implications for public health planning, the proposed framework is flexible, replicable, and robust to be utilized in other similar regions, particularly in developing countries in the tropics and sub-tropics.
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Malik MW, Ikram A, Safdar RM, Ansari JA, Khan MA, Rathore TR, Ashraf N, Basry R, Waqar W, Tahir MA, Qamar MA, Ahmed H. Use of public health emergency operations center (PH-EOC) and adaptation of incident management system (IMS) for efficient inter-sectoral coordination and collaboration for effective control of Dengue fever outbreak in Pakistan - 2019. Acta Trop 2021; 219:105910. [PMID: 33831344 DOI: 10.1016/j.actatropica.2021.105910] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 01/09/2023]
Abstract
Public Health Emergency Operations Center (PH-EOC) and Incident Management System (IMS) provides a platform for inter-sectoral coordination, and collaboration to enhance efficiency of response activities and help in effective control of disease outbreaks. Dengue fever (DF) is an emerging serious public health threat with a potential to transform into a public health emergency. Pakistan faced a heavy outbreak of Dengue fever (DF) from August to December 2019. National Institute of Health (NIH), Islamabad activated its Public Health Emergency Operations Center (PH-EOC) with an objective to implement principles and practices of IMS for control of the outbreak. The challenges during inter-sectoral collaboration for response activities were also identified. PH-EOC was activated on 16th September 2019, and remained operational for next 81 days till 05th December 2019. Incident management structure, incident action plan (IAP), and risk communication plan was developed and executed during this phase. Daily morning and evening meetings were held during all operational days. Federal and provincial health departments, district health offices (DHO), and government/private hospitals were coordinated for collection of the data pertaining to Dengue confirmed cases and deaths. As of 05th December 2019, a total of 52,877 confirmed Dengue cases were reported from all across Pakistan with maximum cases reported from Rawalpindi and Islamabad collectively i.e. 20,988 (40%), followed by Karachi 14,768 (28%), and Peshawar 2,699 (5%), while AJK reported 1,690 (3%). A total of 92 deaths happened all across Pakistan, out of which 43 (47%) happened in Karachi, 23 (25%) in Rawalpindi, and 22 (24%) in Islamabad. The response was coordinated through NIH based PH-EOC, but was carried out by relevant federal and provincial district health offices, vector surveillance programs, dengue control programs and sanitation departments respectively. As a part of response plan, vector surveillance, larva source management, and insecticidal spraying i.e. both fogging and indoor residual spraying activities were carried out in hotspots or the areas where confirmed cases were reported. Sanitation departments daily reported the removal of additional 80-100 ton of solid waste from hotspot areas. Hospitals were coordinated for reporting of isolation of DF patients and provision of quality clinical management for admitted patients. The International Federation for Red Cross/Crescent conducted community awareness, and covered 28,800 households in affected areas of Islamabad. Conversely, the DF outbreak was controlled 02-03 weeks ahead of previous years trends. All the coordinated activities were incorporated in a daily situation report (SitRep) and this was widely distributed among all the stakeholders through emails. Additionally, the data was displayed on the dashboard in PH-EOC. The data dashboard at PH-EOC served as an information management hub that visually mapped, tracked, analyzed, and displayed clusters of DF cases and hotspots. Accordingly, SitRep substantiated as the main reporting tool to monitor response activities initiated by rapid response teams at the national and subnational level. The inter-sectoral coordinating efforts made among concerned line departments resulted in a timely response leading to effective handling of a national public health threat. The information distilled from this experience was that the early and judicious activation of PH-EOC with adaptation of IMS under decision making leadership resulted in a well-managed and prompt response executed by different departments/stakeholders, and effective control of the outbreak before its transformation into a public health event/emergency of national or international concern.
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Affiliation(s)
- Muhammad Wasif Malik
- National Institute of Health (NIH), Islamabad, Pakistan; Field Epidemiology & Disease Surveillance Division, National Institute of Health (NIH), Islamabad, Pakistan.
| | - Aamer Ikram
- National Institute of Health (NIH), Islamabad, Pakistan
| | - Rana Muhammad Safdar
- National Institute of Health (NIH), Islamabad, Pakistan; Field Epidemiology & Disease Surveillance Division, National Institute of Health (NIH), Islamabad, Pakistan
| | - Jamil Ahmed Ansari
- Field Epidemiology & Disease Surveillance Division, National Institute of Health (NIH), Islamabad, Pakistan
| | - Mumtaz Ali Khan
- Field Epidemiology & Disease Surveillance Division, National Institute of Health (NIH), Islamabad, Pakistan
| | - Tayyab Razzi Rathore
- Field Epidemiology & Disease Surveillance Division, National Institute of Health (NIH), Islamabad, Pakistan
| | - Nosheen Ashraf
- Field Epidemiology & Disease Surveillance Division, National Institute of Health (NIH), Islamabad, Pakistan
| | - Rabia Basry
- Field Epidemiology & Disease Surveillance Division, National Institute of Health (NIH), Islamabad, Pakistan
| | - Wajiha Waqar
- Field Epidemiology & Disease Surveillance Division, National Institute of Health (NIH), Islamabad, Pakistan
| | - Majid Ali Tahir
- Field Epidemiology & Disease Surveillance Division, National Institute of Health (NIH), Islamabad, Pakistan
| | - Muhammad Akram Qamar
- Field Epidemiology & Disease Surveillance Division, National Institute of Health (NIH), Islamabad, Pakistan
| | - Haroon Ahmed
- Department of Biosciences, COMSATS University Islamabad (CUI), Park Road, Chakh shshzad, Islamabad, Pakistan
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Baloch Z, Shen Z, Zhang L, Feng Y, Li D, Zhang NN, Deng YQ, Yang C, Sun X, Dai J, Yang Z, Qin CF, Xia X. Recapitulating Zika Virus Infection in Vagina of Tree Shrew (Tupaia belangeri). Front Cell Infect Microbiol 2021; 11:687338. [PMID: 34249779 PMCID: PMC8270636 DOI: 10.3389/fcimb.2021.687338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/10/2021] [Indexed: 01/03/2023] Open
Abstract
Sexual transmission of Zika Virus (ZIKV) elevates the risk of its dissemination in the female reproductive tract and causes a serious threat to the fetus. However, the available animal models are not appropriate to investigate sexual transmission, dynamics of ZIKV infection, replication, and shedding. The use of tree shrew as a small animal model of ZIKV vaginal infection was assessed in this study. A total of 23 sexually mature female tree shrews were infected with ZIKV GZ01 via the intravaginal route. There was no significant difference in change of body weight, and the temperature between ZIKV infected and control animals. Viral RNA loads were detected in blood, saliva, urine, and vaginal douching. ZIKV RNA was readily detected in vaginal lavage of 22 animals (95.65%, 22/23) at 1 dpi, and viral load ranged from 104.46 to 107.35 copies/ml, and the peak of viral load appeared at 1 dpi. The expression of key inflammatory genes, such as IL6, 8, CCL5, TNF-a, and CXCL9, was increased in the spleen of ZIKV infected animals. In the current study, female tree shrews have been successfully infected with ZIKV through the vaginal route for the first time. Interestingly, at first, ZIKV replicates at the local site of infection and then spreads throughout the host body to develop a robust systemic infection and mounted a protective immune response. This small animal model is not only valuable for exploring ZIKV sexual transmission and may also help to explain the cause of debilitating manifestations of the fetus in vivo.
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Affiliation(s)
- Zulqarnain Baloch
- Faculty of Life Science and Technology, Yunnan Provincial Center for Molecular Medicine, Kunming University of Science and Technology, Kunming, China
| | - Zhili Shen
- Faculty of Life Science and Technology, Yunnan Provincial Center for Molecular Medicine, Kunming University of Science and Technology, Kunming, China
| | - Li Zhang
- Faculty of Life Science and Technology, Yunnan Provincial Center for Molecular Medicine, Kunming University of Science and Technology, Kunming, China
| | - Yue Feng
- Faculty of Life Science and Technology, Yunnan Provincial Center for Molecular Medicine, Kunming University of Science and Technology, Kunming, China
| | - Daoqun Li
- Faculty of Life Science and Technology, Yunnan Provincial Center for Molecular Medicine, Kunming University of Science and Technology, Kunming, China
| | - Na-Na Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Yong-Qiang Deng
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Chunguang Yang
- Key Laboratory of Animal Models and Human Disease Mechanisms, Kunming Institute of Zoology, Chinese Academy of Sciences, Center of Tree Shrew Germplasm Resources, Institute of Medical Biology, Chinese Academy of Medical Science and Peking Union Medical College, Kunming, China
| | - Xiaomei Sun
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiejie Dai
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zifeng Yang
- Key Laboratory of Animal Models and Human Disease Mechanisms, Kunming Institute of Zoology, Chinese Academy of Sciences, Center of Tree Shrew Germplasm Resources, Institute of Medical Biology, Chinese Academy of Medical Science and Peking Union Medical College, Kunming, China
| | - Cheng-Feng Qin
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Xueshan Xia
- Faculty of Life Science and Technology, Yunnan Provincial Center for Molecular Medicine, Kunming University of Science and Technology, Kunming, China
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11
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Wang G, Zhang A, Wang B, Yin J, Feng Y, Baloch Z, Xia X. The homology analysis of ACE2 gene and its distinct expression in laboratory and wild animals.. [DOI: 10.1101/2021.04.08.439088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
AbstractAngiotensin-converting enzyme-2 (ACE2) has been recognized as an entry receptor of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) into the host cells while bats has been suspected as natural host of SARS-CoV-2. However, the detail of intermediate host or the route of transmission of SARS-CoV-2 is still unclear. In this study, we analyze the conservation of ACE2 gene in 11 laboratory and wild animals that live in close proximity either with Bats or human and further investigated its RNA and protein expression pattern in wild bats, mice and tree shrew. We verified that the wild-bats and mice were belonged to Hipposideros pomona and Rattus norvegicus, respectively. ACE2 gene is highly conserved among all 11 animals species at the DNA level. Phylogenetic analysis based on the ACE2 nucleotide sequences revealed that wild bat and Tree shrew were forming a cluster close to human. We further report that ACE2 RNA expression pattern is highly species-specific in different tissues of different animals. Most notably, we found that the expression pattern of ACE2 RNA and protein are very different in each animal species. In summary, our results suggested that ACE2 gene is highly conserved among all 11 animals species. However, different relative expression pattern of ACE2 RNA and protein in each animal species is interesting. Further research is needed to clarify the possible connection between different relative expression pattern of ACE2 RNA and protein in different laboratory and wild animal species and the susceptibility to SARS-CoV-2 infection.
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12
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Anwar F, Tayyab M, Salman M, Abdullah, Din M, Khan J, Haq I. Dengue outbreak 2018 in district Shangla KPK; clinical features and laboratory markers of dengue virus infection. Future Virol 2020. [DOI: 10.2217/fvl-2019-0130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Aim: To analyze and quantify the 2018 dengue outbreak which occurred in district Shangla, Pakistan. Materials & methods: 964 suspected dengue samples were collected and examined for clinical manifestation and laboratory markers. Results: In all, 375 suspected cases were confirmed with dengue virus infection using nonstructural protein 1 (NS1) antigen, immunoglobulin M (IgM) & Immunoglobulin G (IgG) antibodies and real-time PCR whereas PCR was 92.2% sensitive. The most prevalent serotype was dengue virus 3 (60.26%). The male/female ratio was 1.84 and the most highly affected tehsil was Alpuri. The most affected age group was 16–40 years (70.4%). A significant number of cases were reported in September (48.54%). Conclusion: Recurrence of the dengue outbreaks in the study area could alarmingly increase the mortality rate, therefore, proper measures are essential to control dengue epidemics in the future.
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Affiliation(s)
- Faheem Anwar
- Department of Genetics, Hazara University, Mansehra Pakistan
| | - Muhammad Tayyab
- Institute of Biotechnology & Genetic Engineering (IBGE), The University of Agriculture, Peshawar, Pakistan
- Author for correspondence:
| | - Muhammad Salman
- Department of Microbiology & Biotechnology, Abasyn University, Peshawar, Pakistan
| | - Abdullah
- Department of Microbiology & Biotechnology, Abasyn University, Peshawar, Pakistan
| | - Misbahud Din
- Department of Biotechnology, Quaid-I-Azam University, Islamabad, Pakistan
| | - Jawad Khan
- Department of Genetics, Hazara University, Mansehra Pakistan
| | - Ihteshamul Haq
- Graduate School of Biotechnology & Oriental Medicine Kyunghee University, Suwon, South Korea
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Rehman FU, Omair SF, Memon F, Amin I, Rind BJ, Aziz S. Electrolyte Imbalance at Admission Does Not Predict the Length of Stay or Mortality in Dengue-Infected Patients. Cureus 2020; 12:e10419. [PMID: 33062534 PMCID: PMC7553718 DOI: 10.7759/cureus.10419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background A pattern of both clinical and biochemical abnormalities is associated with dengue virus infection (DVI). Among the various DVI-related biochemical defects, electrolyte imbalance is one that can alter the morbidity and mortality among patients. However, there is a dearth of evidence to assess the relationship between electrolyte imbalance and the length of stay or mortality in dengue-infected patients in Pakistan. In the current study, we aimed to investigate the association between electrolyte imbalance at the time of admission and the length of stay and mortality among dengue-infected patients. Methods We conducted a retrospective study at a large tertiary care hospital from November 2018 to November 2019. All patients with known chronic diseases and coinfections or those who were taking diuretics therapies or angiotensin-converting enzyme inhibitors were excluded. Our main exposure of interest was electrolytes imbalance and the outcome measure was the length of stay and mortality. Results A total of 1,008 dengue patients were enrolled with a mean length of stay of 2.56 days. Around 29.3% had hyponatremia and 23.2% had hypokalemia at the time of admission, and 21.9% of patients had a stay beyond three days. In multivariable analysis, hyponatremia [adjusted odds ratios (aOR) = 1.29; 95% confidence interval (CI): 0.59-2.84] and hypokalemia (aOR = 2.36; 95% CI: 0.91-6.10) were not found to be associated with the length of stay. However, patients with high troponin levels at admission had a prolonged stay beyond three days (aOR = 5.74; 95% CI: 2.34-14.11). There was a statistically significant association of creatinine levels (aOR = 14.74; 95% CI: 4.19-15.85) and diabetes mellitus (DM) (aOR = 4.36; 95% CI: 1.21-15.74) with mortality after controlling for potential confounders. Conclusion Electrolyte imbalance at admission is not a predictor of length of stay or fatalities in the hospital among patients with DVI. However, troponin levels at admission can increase hospitalization days whereas DM and renal injury have been found to worsen mortality rates.
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Affiliation(s)
| | | | - Fatima Memon
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | - Bakhtawar J Rind
- Medicine, Jam Ghulam Qadir Hospital Hub District Lasbela, Quetta, PAK
| | - Sumera Aziz
- Community Health Sciences, Aga Khan University hospital, Karachi, PAK
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14
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Sahak MN. Dengue fever as an emerging disease in Afghanistan: Epidemiology of the first reported cases. Int J Infect Dis 2020; 99:23-27. [PMID: 32738489 DOI: 10.1016/j.ijid.2020.07.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/14/2020] [Accepted: 07/18/2020] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE This paper aims to describe the epidemiological characteristics and clinical manifestations of the first 15 dengue fever cases reported in Afghanistan. METHODS A retrospective descriptive analysis of the data on confirmed dengue cases detected by the national disease surveillance system was conducted. Epidemiological, socio-demographic, clinical, laboratory and outcome data from the cases were analyzed. RESULTS Between May and December 2019, 62 samples were tested for DENV, among which 15 (24.2%) were positive. Seven of the cases were probable autochthonous with no travel history, the other seven cases had a travel history to dengue-endemic countries (five Pakistan, two India) and the travel history for one of the cases was not known. The 15 confirmed cases were reported from six provinces, seven cases (46.7%) were reported from Nangarhar Province, two (13%) from Paktya, and one (6.7%) from Paktika province, bordering with Pakistan, three (20%) were reported from Kabul, and one each (each 6.7%) from Faryab and Laghman provinces. All of the cases manifested fever, headache, myalgia, and arthralgia. Other clinical features were low platelet count (50%), pain behind eyes (36%), rash, and nausea/vomiting (each 21%). CONCLUSION For the first time, the surveillance system detected and reported locally acquired DENV cases in Afghanistan, mostly in provinces bordering with Pakistan. Population movements between Afghanistan and Pakistan facilitate the cross-border spread of DENV between two countries.
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15
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Wahid B. Current status of dengue virus, poliovirus, and chikungunya virus in Pakistan. J Med Virol 2019; 91:1725-1728. [PMID: 31251402 DOI: 10.1002/jmv.25513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 05/31/2019] [Accepted: 06/03/2019] [Indexed: 11/10/2022]
Abstract
Epidemics of infectious diseases especially dengue virus (DENV), chikungunya virus (CHIKV), and poliovirus are the leading cause of mortality and morbidity in Pakistan. Risks associated with these outbreaks have drastic effects on the healthcare infrastructure and economy of the country. This report provides the current status of DENV, poliovirus, and CHIKV in Pakistan and further highlights the measures needed to control these infections.
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Affiliation(s)
- Braira Wahid
- Department of Life Sciences, School of Science, University of Management and Technology, Lahore, Pakistan
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