Abstract
Arboviral diseases are expanding worldwide, yet global surveillance is often limited due to diplomatic and cultural barriers between nations. With human encroachment into new habitats, mosquito-borne viruses are also invading new areas. The actual prevalence of expanding arboviruses is unknown in Pakistan due to inappropriate diagnosis and poor testing for arboviral diseases. The primary objective of this study was to document evidence of flavivirus infections as the cause of undifferentiated fever in Pakistan. Through a cooperative effort between the USA and Pakistan, patient exposure to dengue virus (DENV), West Nile virus (WNV), and Japanese encephalitis virus (JEV) was examined in Sindh Province for the first time in decades. Initial results from the 2015 arbovirus season consisting of a cross-sectional study of 467 patients in 5 sites, DENV NS1 antigen was identified in 63 of the screened subjects, WNV IgM antibodies in 16 patients, and JEV IgM antibodies in 32 patients. In addition, a number of practical findings were made including (1) in silico optimization of RT-PCR primers for flavivirus strains circulating in the Middle East, (2) shipping and storage of RT-PCR master mix and other reagents at ambient temperature, (3) Smart phone applications for the collection of data in areas with limited infrastructure, and (4) fast and reliable shipping for transport of reagents and specimens to and from the Middle East. Furthermore, this work is producing a group of highly trained local scientists and medical professionals disseminating modern scientific methods and more accurate diagnostic procedures to the community.
Highlights
Political boundaries do not constrain human, animal, or plant diseases
Febrile patients with West Nile virus (WNV) exposure were found at four sites with eight of the patients living in Karachi, two in Hyderabad, two in Larkana, and one in Mirpurkhas (Table 4)
The expansion of dengue virus (DENV) in Pakistan has been notable in its intensity
Summary
Political boundaries do not constrain human, animal, or plant diseases. As humans and animals migrate across these borders, their associated diseases relocate in tandem. Encroaching diseases are often overlooked because of limited surveillance, political motivation, resources, and infrastructure [1]. Undifferentiated Fever in Sindh Province, Pakistan occurs in a politically neutral atmosphere that can have rapid positive and sustainable impacts on human and animal health and the control of emerging diseases [2, 3]. The growth in scientific personnel and infrastructure is essential to decrease the movement of diseases that threaten public health [1, 4,5,6,7]. Many outbreaks since 1990 like prion disease in the UK, West Nile virus (WNV) in the America’s, and avian H5N2 in Canada and the US have been economically destabilizing and highlight the need for transboundary collaboration [8]
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