The ongoing surge of dengue amidst a multidemic era in Pakistan

Abstract

Dengue fever has been one of the unresolved problems around the globe since the 1950s. Recently, it has become endemic in more than 100 countries, resulting in more than 390 million cases causing up to 36,000 deaths annually around the globe. About half of the world’s population is at risk due to the sharp increase in dengue incidence worldwide1. The causative agent of this disease is a virus belonging to a family of Flaviviridae (single-strand RNA viruses), transmitted by the female Aedes mosquito that breeds in water. The disease is more common in humid, rainy climates, with stagnant water, and crowded urban populations. It has 4 serotypes (DENV-1, DENV-2, DENV-3, DENV-4), and 1 or more serotypes can cause this illness. However, infection with any serotype will give lifelong immunity to that particular serotype2. Every year, Pakistan faces the dengue surge mostly in or after the heavy monsoon, from July to October. Dengue virus (DENV) has been endemic since 2011 throughout the country and has caused many deaths during the last decade. The disease has significantly expanded during the last few years in the country, reporting 22,938 cases in 2017 and 48,906 cases in 20213. This year monsoon rains in Pakistan were catastrophic due to a lack of proper infrastructure, and a substandard health care system. Currently, Pakistan is facing yet another surge in dengue cases along with various other infectious diseases secondary to flood catastrophes. The stagnant and contaminated flood water in the country is flourishing the vector activity4. The infected patients present with high-grade fever, vomiting, headache, body pain, and rashes. These patients are often misdiagnosed due to some similar other common illnesses like malaria and Coronavirus Disease 2019 (COVID-19)1,5. In addition, the ongoing COVID-19 pandemic is resulting in a divergence of attention6. According to the latest reports, Pakistan in 2022 has reported 7951 cases in Sindh, 4921 in Punjab, 6625 in Khyber Pakhtunkhwa, and 1991 cases in the national capital Islamabad with peak cases reported in September alone. More than 75% of the patients presenting to the hospital are reported to have dengue7. In addition, the disease is putting an enormous economic burden on patients being treated in government setups, nearing 10,000 tks (22,864 pkr) ~US$94, too high for a low-middle income country like Pakistan, where the minimum wage is as less as US$103 as of 20228. Also, a few reports on a general public survey stated that people are trying to cure their dengue illness with papaya leaves, which often worsens the disease as papaya leaves cause diarrhea9. Although it is a difficult time for Pakistan to handle this multidemic era and catastrophic conditions due to floods. With World Health Organization (WHO) aid, the Pakistan government and health authorities should implement strategic and effective measures to counter this dengue surge. Various preventive measures for dengue prevention, that is, removing stagnant water from ponds and lakes, application of spray for killing the mosquito larvae, providing mosquito nets to the general public, and availability of common medicines. Also, community education and awareness on vector control interventions like maintaining proper living hygiene, and the use of repellents are strongly recommended. Ethical approval None. Sources of funding None. Author contributions Sidhant O.: conceptualization and literature search. Sidhant O., Simaran O. A.O., and K.O.: wrote the manuscript. Sidhant O., A.A., and K.U.: review the editing. A.A.: formatting and referencing. Conflict of interest disclosures The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) None. Guarantor Sidhant Ochani.