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Pakistan: Dengue Response Emergency Plan of Action (EPoA) DREF Operation n° MDRPK022

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A. Situation analysis

Description of the disaster Dengue fever is a year-round and nationwide risk in Pakistan. According to the National Institute of Health (NIH) Islamabad, 22,938 dengue fever cases were reported in Pakistan in 2017, more than 3,200 in 2018, 24,547 cases in 2019 and 3,442 cases in 2020. 2021 also sees a rise in the cases especially in Lahore and the twin cities, Rawalpindi and Islamabad. Since 8 October 2021, Islamabad has been facing a continuous rise in dengue fever cases, leading to pressure on public and private hospitals, according to the district health officer. While the Government is responding in Lahore, the Ministry of Health (MOH) requested the support of PRCS for response to control and prevent the disease in Rawalpindi and Islamabad on 12 October in a meeting with the Secretary General of PRCS.

Islamabad is singled out by the health authorities, after Punjab, as the city is facing a continuous rise in dengue fever cases during the past few weeks. This has built up pressure on the public sector and private hospitals amid the COVID-19 pandemic. In Islamabad, dengue larvae were found at 53 different spots during the anti-dengue surveillance in the city. The highest number of cases have been reported in Tarlai Kalan with 55 cases, followed by 17 in Koral, and nine each in Alipur and Tarnol. As of 12 October, at least 113 people contracted the fever with five more fatalities and more than 200 patients are treated at different hospitals. Moreover, 13 October turned out to be the third consecutive day when the capital reported over 100 dengue fever patients, 115, thus taking the overall number of cases in the capital to 1,458. This trend is alarming for the capital and immediate actions are required to be taken.

According to the district health officer, 948 cases were reported from rural areas while 470 cases were confirmed in urban areas of Islamabad. The district health teams are actively engaged in containing the spread by destroying the mosquito breeding sites through spray and fumigation. The Islamabad administration has launched an anti-dengue campaign in response to the alarmingly high levels of dengue fever cases.

With the precarious nature of the situation, immediate attention is required to control the spread. The situation can be worsening as there is no suitable treatment available for dengue fever. Clinicians mainly treat dengue fever patients’ symptoms and boost immunity focusing on fluid and electrolyte balance and supplement with vitamin C thus halting the progression of viral infection to its haemorrhagic state. Dengue vaccines are not commercially available in Pakistan,

In some cases, Dengue infection is asymptomatic – people do not exhibit symptoms. Those with symptoms get ill between 4 to 7 days after the bite. The infection is characterized by flu-like symptoms which include a sudden high fever coming in separate waves, pain behind the eyes, muscle, joint, and bone pain, severe headache, and a skin rash with red spots. In Pakistan, there is a general observation that people do not consult with doctors unless it gets serious. In the case of dengue, the symptoms are like malaria and people rely on home remedies and do not see a doctor. This mentality contributes to worsening the situation.

Health education is proven to be an essential step in any vector control programme which implies sustaining efficient information and scientific knowledge to society on transmitted diseases and their vectors. The knowledge of the vector life cycle and its ecology and biology should be delivered to help people to live in healthy conditions and destruction of vector breeding sites.

Disease Scenario and effectiveness of different protective measures

Aedes aegypti and Aedes albopictus as shown above have been considered major vectors of dengue in Southeast Asia including Pakistan. Both species have been closely associated with human dwellings due to their breeding preference for clean water domestic habitats. Similarly, both species also exhibit a discernible demarcation in occurrence in different geographical areas of the country. Disease prevalence is likely to happen in the capital region because of the presence of both types of vectors but the dominance of Aedes aegypti while Aedes albopictus also shows reasonably high densities.

In addition to the presence of vectors, frequent travel between the twin cities and adjacent areas, population growth in the peripheral areas of both Islamabad and Rawalpindi where there are improper sanitation facilities and ineffective mosquito control measures are contributing factors to the spread of the virus. Minimum disease surveillance and official reporting of cases is also a threat of prevalence to other adjacent areas. Provision of Long-Lasting Insecticidal Nets (LLINs), mosquito repellent, awareness-raising at community and educational institute level through this project activity aims to control spread and increase awareness of vulnerable communities about the control and preventive measures of vector transmission.

Aedes aegypti is a daytime feeder - the peak biting periods are early in the morning and in the evening before dark. Dengue virus spreads through a human-to-mosquito-to-human cycle of transmission, with a person developing viremia after four days of being bit by an infected Aedes aegypti mosquito. In the viremia stage, the infected person develops a high level of dengue virus in the blood. The infected person will remain asymptomatic on the first few days of viremia and will develop symptoms after five days which lasts for 12 days minimum. A mosquito that feeds on the blood of someone infected with the dengue virus also becomes a dengue vector. The mosquito must take its blood meal during the period of viremia when the infected person has high levels of the dengue virus in the blood. Once the virus enters the mosquito's system in the blood meal, the virus spreads through the mosquito's body over 8 to 12 days. After this period, the infected mosquito can transmit the dengue virus to another person while feeding. Once infected with dengue, the mosquito remains infected with the virus for its entire life and can continue transmitting the dengue virus to healthy people for the rest of their life spans, generally a three-to-four-week period.