Outbreak In Pakistan Research Articles

Blood Transfusion Practices in Dengue Fever: A Cross Sectional Single Center Study During a Dengue Outbreak in Pakistan

Introduction: Dengue fever (DF) is a global health problem in tropical and subtropical regions across the globe. Pakistan has become one of the countries which are hit by its outbreaks for the past two decades with the first outbreak reported in 1994.It is a mosquito-borne infection which is transmitted to humans from the mosquito bite. Characteristics of dengue fever are thrombocytopenia, coagulopathy and increased capillary permeability. The disease spectrum ranges from mild fever to life threatening hemorrhagic shock syndrome; hemorrhagic manifestations are the most feared complications of the disease. Guidelines regarding fluid management in dengue fever have been established by Center for Disease Control (CDC) and local national bodies in Pakistan however comprehensive data regarding blood product usage is lacking. Understanding the rationale use of blood products can reduce burden on blood bank inventories as well as reduce unnecessary blood product exposure to the patients in dengue outbreak.
 Aims & Objectives: Assessment of compliance of physicians and transfusion provision authorities regarding blood products usage with local and international guidelines in managing dengue outbreak.
 Place and duration of study: This study was conducted at Chughtai Institute of Pathology, Lahore from September 2021 to November 2021.
 Material & Methods: It was a cross sectional study. Total 107 patients who were non-structural antigen1(NS1) positive confirmed dengue infection presented at Chughtai Blood Bank for request of any blood product were included in the study; individuals with existing cytopenia (known cases) unrelated to Dengue (NS1 antigen positive) were excluded. Data was recorded on a pre-designed Performa/questionnaire. Statistical analysis was performed using SPSS 23.0. Frequencies were calculated and expressed as percentages.
 Results: Mean Age of 107 patients was 53 years (±19.05) out of which 63(58.9%) were males and 44(41.1%) were females. Blood products requested were platelets in 93(86.9%) patients, platelets and fresh frozen plasma in 3(2.8%), platelets and whole blood in 9(8.4%) and whole blood in 2(1.9%) patients. Therapeutic platelet transfusions were done in 35(32.7%) patients and prophylactic platelet transfusions were done in 72(67.3%) patients.
 Conclusion: Lack of practicing evidence-based guidelines and inappropriate usage of blood products during dengue epidemic overburdens health care facilities and adds to the stress and panic. A well-coordinated centralized management system for dengue outbreak can play pivotal role in guiding rationale use of blood products.

West Nile virus outbreak in Pakistan: Another potential public health threat in the pipeline?

West Nile virus (WNV), a single-stranded RNA virus belonging to the family of Flaviviridae, is an arbovirus transmitted to humans predominantly by mosquito bites. It exhibits a wide range of clinical findings ranging from asymptomatic presentation to severe several neurological disorders. WNV has afflicted several countries around the globe including Pakistan. News of yet another outbreak in the country by WNV is circulating again. Concerned authorities should act vigilantly before the endemic takes over completely and bring down the already bereaving healthcare of Pakistan.

A Systematic Review and Meta-Analysis of Prevalence of Depressive Symptoms among Healthcare Workers in Pakistan during Covid Pandemic

Workload and stress of healthcare workers has increased manifolds as result of COVID-19. Healthcare workers in developing countries like Pakistan face lack of resources and psychological support in addition to changes in work routines, fear, isolation and separation from families. We conducted a systematic review and meta-analysis of prevalence of depressive symptoms among healthcare workers in Pakistan during COVID-19 pandemic. PubMed and Google Scholar were searched on January 2nd 2022. We included cross-sectional studies published during COVID outbreak in Pakistan (from January 2020 to December 2021). We extracted data on study characteristics and depression prevalence. Random effects models was used to conduct Meta-analysis. In total, 10 studies involving 12507 participants were included. The pooled prevalence of depression was 25.5% (95% CI, 19.5% to 32.5%), with significant between-study heterogeneity (I2= 95.83%, Q=216.15, p < 0.001). This calls for urgent actions and interventions to support mental health care of healthcare workers in Pakistan. Keywords: Depression, Healthcare Workers, Prevalence, Pakistan, COVID-19

Clinico-hematological features and outcome of patients affected by Congo–Crimean hemorrhagic fever: An experience from a single center

BACKGROUND: Congo–Crimean hemorrhagic fever is a tick-borne zoonotic viral disease caused by Crimean–Congo hemorrhagic fever virus (CCHFV). The outbreak in Pakistan is increased during Eid-ul-Adha. We describe a cluster of cases that presented to our hospital. AIMS: The aim of this study was to determine the outcome of Crimean–Congo hemorrhagic fever-positive cases from January 2011 to August 2019. MATERIALS AND METHODS: Retrospective data were retrieved using the International Classification of Diseases version 9. We received 2101 samples for testing. Polymerase chain reaction (PCR)-positive cases were included in the study. History of bleeding and animal contact was recorded. Variables analyzed were age, gender, profession, and coinfection with other viral illnesses. RESULTS: A total of 70 PCR-positive cases were included in the study (frequency 3.3%). Sixty-one were males and nine were females. Fever was present in all cases. Epistaxis was noted in 54% of patients. Thrombocytopenia was present in all patients. Eighteen patients were butchers, six were shopkeepers, nine students, and few laborers. All females were housewives. Twenty-two patients had a history of contact with animals. Seven patients were coinfected with viral hepatitis. There were 23 (33%) deaths. CONCLUSION: Overall mortality was 33%. Twenty-two patients had a history of contact with animals. There is a strong need for public education, especially during the month of Eid-ul-Adha.

How Does COVID-19 Affect Demographic, Administrative, and Social Economic Domain? Empirical Evidence from an Emerging Economy

Worldwide, the COVID-19 pandemic has had a significant impact on social and economic conditions as well as mental and physical health. Pakistan is considered in high ranks on Uncertainty Avoidance Index (UAI). The people of Pakistan have already faced numerous obstacles in terms of food and housing prospects. Job security, inflated prices of food items, and financial distress are the foremost vital challenges of Pakistan’s people during the Pandemic. This study examines the people’s perception of social, economic, and psychological impact and explores the causes and trends of spreading the COVID-19 pandemic in Pakistan. A primary survey method was conducted to collect the data from all Punjab divisions via questionnaire, and 471 respondents were finally selected for data analysis. The data collection instrument was a questionnaire, and the data analysis tool was SPSS. Investors, analysts, business professionals, economists, business faculty staff, and civil society are the study’s populations. The findings show that the overall social and economic life has been affected (82% of respondents agree) by the COVID-19 pandemic. 60.5% of respondents manage their spending through salary (mean value = 4.45), while 45% use savings (mean value = 4.25). Moreover, Government support (mean value = 3.95) plays a vital role in managing expenditure in this COVID-19 outbreak in Pakistan. Consequently, this study confirms that the lock-down implementation measure (mean value = 2.20) is not considered useful in reducing COVID-19 due to Pakistan’s financial and economic uncertainty. This study concluded the social distance and testing measures are vital tools in reducing the COVID-19 pandemic in Pakistan. However, the study established that micro-smart lockdown, increased COVID-19 testing kits, and adequate medical equipment in the Hospital of Pakistan are the key mechanism to control the pandemic. Consequently, this study recommends that thorough long-term planning be undertaken to mitigate the pandemic’s worst effects and develop a comprehensive strategy with society as the primary focus.

Chikungunya virus: Molecular epidemiology of nonstructural proteins in Pakistan.

Chikungunya virus (CHIKV) is considered a public health problem due to its rapid spread and high morbidity. In 2016–2017 an outbreak of CHIKV was occurred in Pakistan but the data regarding the genomic diversity of CHIKV was not reported. Hence, the current study aimed to determine the genetic diversity of CHIKVs in Pakistan. A cross sectional study was carried out using sera of infected CHIKV patients (n = 1549) during the outbreak in Pakistan (2016–2018). Nucleotide sequencing of non-structural genes of CHIKV from eight isolates were performed followed by phylogenetic analysis using Bayesian method. Phylogenetic analysis suggested that the Pakistani CHIKV strains belonged to Indian Ocean Lineage (IOL) of genotype ECSA and C1.3a clade. Furthermore, the Pakistani isolates showed several key mutations (nsP2-H130Y, nsP2-E145D, nsP4-S55N and nsP4- R85G) corresponding to mutations reported in 2016 Indian strains of CHIKV. The molecular analysis revealed high evolutionary potential of CHIKV strains as well as better understanding of enhanced virulence and pathogenesis of this outbreak. The study highlights the need to continue surveillance in order to understand viral diversity over time and to devise preventive measures to limit diseases transmission in the region.

Readiness of Medical Institutions, Academics and Practitioners for the Covid-19 Outbreak

Objective: To assess the readiness of medical institutions (academics and practitioners) to the COVID-19 outbreak in Pakistan.  Methods: It was a cross-sectional study. Two medical institutes were contacted in Sind and Punjab through the Vice Chancellors. Faculty members were asked to fill the questionnaire online. Convenience sampling was done, with no fixed sample size. Questionnaires were sent as google forms. Duration of the study was 4 months (Aug 2020 – Nov 2020).   Results: Out of 111 participants, there were 64 females and 47 males. Clinical faculty gave more correct answers on major warning signs of COVID-19 (35.6%) as compared to the basic science faculty (16.7%). Private sector is more prepared to deal with COVID in terms of availability of infection control materials and following of SOPs, however, public sector showed improved numbers (59.1%) for “Performing refresher training for HCP on infection control guidelines” as compared to private sector (33.7%). Total subjective score on IES range from 25 – 30 out of 75 in different groups which showed moderate stress.  The two most practiced life style modifications were avoiding crowded places and frequently washing the hands. The thought of passing on infection to the loved ones was found to be most worrisome for them.  Conclusion: The pandemic is a source of stress for healthcare workers. The institutional readiness for dealing with the pandemic needs consideration at institutional, government and policy level for better equipping the healthcare facilities with the infection control materials and PPEs.

Evaluating ICT utilization in education administration and management during the COVID-19 outbreak in Pakistan: An empirical review

This study aims to evaluate the utilization of ICT in education administration and management in a Pakistan context during the pandemic outbreak. Adoption of information and communication technologies (ICTs) has digitalized the learning process where education organizations were administrated by means of wireless-based instructions, electronic pedagogy, and online assessment in order to continue the educational activities while the government halted the physical appearance in education institutions. Data collection has been carried by three public universities in which teachers and general administration of these institutions participated to discover their intention to use the assigned technology to administrate organizations’ policies in the way to disseminate the respective service delivery. Survey questionnaires were used, and 178 respondents’ feedback was secured to analyze the study that was carried out via SPSS version 24 and validation OF hypotheses measured by means of regressions and correlations. Moreover, proposed factors like intention to use, perceived ease of ease, perceived usefulness, social influence, and Users’ expectations were used. A theoretical approach was inculcated to encircle the UTAUT and TAM model to determine the adoption of the innovative system education management during the pandemic outbreak in the country.

Self-Reported Compliance with Personal Preventive Measures among Office Workers After Work Resumption during the COVID-19 Outbreak in Pakistan.

ABSTRACT.As the lockdowns have been lifted to relieve pressure on the economy, strict adherence to personal preventive measures (PPMs) in offices is essential to control the COVID-19 pandemic. This study investigated self-reported compliance with three PPMs among a sample of office workers in Karachi, Pakistan. A cross-sectional survey with participants were adult office workers who had resumed work in Karachi, Pakistan. All full-time employees aged ≥ 18 years who had resumed work in the offices were invited to complete the survey. Of 487 workers who were invited, 411 (84.4%) completed the survey between March 1 and March 20, 2021. We examined the effects of sociodemographic factors, individual-level factors, interpersonal-level factors, and social-structural–level factors using logistic regression models. Of the total sample, 192 (46.7%) reported always wearing a face mask in the workplace. Self-reported sanitizing of hands (46.0%) was comparable to use of face masks, whereas avoiding crowded places (21.2%) was less common. Perceived effectiveness of individual preventive measures (adjusted odds ratios [AORs] from 1.19 to 1.42; confidence intervals (CIs) 1.04–1.37 to CI 1.18–1.71), perceived effectiveness of governmental preventive measures (AORs from 1.23 to 1.39 CI 1.02–1.47 to CI 1.12–1.72), and number of preventive measures implemented by the office (AORs from 1.20 to 1.26 CI 1.09–1.31 to CI 1.13–1.39) were associated with self-reported compliance with PPMs. Perceived preparedness of medical system in Karachi (AOR 1.44, CI 1.08–1.93) was only associated with self-reported sanitizing of hands. Reduced compliance to PPMs was observed; hence, efforts need to be made to ensure strict adherence to PPMs.

Modelling the spread of serotype-2 vaccine derived-poliovirus outbreak in Pakistan and Afghanistan to inform outbreak control strategies in the context of the COVID-19 pandemic.

BackgroundSince July 2019, Pakistan and Afghanistan have been facing an outbreak of serotype-2 circulating vaccine derived poliovirus (cVDPV2) in addition to continued transmission of serotype-1 wild poliovirus (WPV1) and SARS-CoV-2 in 2020. Understanding the risks of cVDPV2 transmission due to pause of global vaccination efforts and the impact of potential vaccination response strategies in the current context of COVID-19 mitigation measures is critical.MethodsWe developed a stochastic, geographically structured mathematical model of cVDPV2 transmission which captures both mucosal and humoral immunity separately and allows for reversion of serotype-2 oral polio vaccine (OPV2) virus to cVDPV2 following vaccine administration. The model includes geographic heterogeneities in vaccination coverage, population immunity and population movement. The model was fitted to historic cVDPV2 cases in Pakistan and Afghanistan between January 2010-April 2016 and July 2019-March 2020 using iterated particle filtering. The model was used to simulate spread of cVDPV2 infection from July 2019 to explore impact of various proposed vaccination responses on stopping transmission and risk of spread of reverted Sabin-2 under varying assumptions of impacts from COVID-19 lockdown measures on movement patterns as well as declines in vaccination coverage.ResultsSimulated monthly incidence of cVDPV2 from the best-fit model demonstrated general spatio-temporal alignment with observed cVDPV2 cases. The model predicted substantial spread of cVDPV2 infection, with widespread transmission through 2020 in the absence of any vaccination activities. Vaccination responses were predicted to substantially reduce transmission and case burden, with a greater impact from earlier responses and those with larger geographic scope. While the greatest risk of seeding reverted Sabin-2 was predicted in areas targeted with OPV2, subsequent spread was greatest in areas with no or delayed response. The proposed vaccination strategy demonstrated ability to stop the cVDPV2 outbreak (with low risk of reverted Sabin-2 spread) by February 2021.ConclusionOutbreak response vaccination campaigns against cVDPV2 will be challenging throughout the COVID-19 pandemic but must be implemented urgently when feasible to stop transmission of cVDPV2.

Infection Control Measures in Pakistani Dental Practices During COVID-19 Outbreak

OBJECTIVE: The objective of this study is to assess infection control measures in dental practices during COVID-19 outbreak in Pakistan. METHODOLOGY: It was a cross-sectional web based survey conducted during COVID-19 outbreak from the period of June 2020 to August 2020. The study participants were the dental surgeons who were either working in hospital setup or running their own private practice or working in private dental setup. The survey consisted of sets of questions to assess whether dental practitioners have implemented strategies to combat novel corona virus infection in their practice. It also consists of questions that assess aerosol generating procedures are commencing with or without out any COVID-19 symptoms. RESULTS: About 39.1% participants reported that 75% of the number of patients in their clinic had been reduced and 52.2% of the participants reported that >50% of the patients came for endodontic procedures with pain. Eighty one percent of the participants were maintaining hand hygiene before touching all patients, 71.7% before any cleaning, 78.3% before any aseptic procedure, 81% after exposure to patient’s fluid and 80.4% after touching. There was low compliance regarding the use of personal protective equipment and almost 62.6% were using eye wear for all patients, 58.7% were disinfecting whole clinical room before new patient and 43.9% were using single use (disposable) examination set during COVID-19 outbreak. CONCLUSION: Majority of dentist in Pakistan were following the recommendations and guidelines of infection control practices related to COVID-19 pandemic. KEYWORDS: COVID-19, coronavirus, infection control measures, practices, dentistry

Knowledge, awareness and practices of Pakistani professionals amid-COVID-19 outbreak

End of the year 2019 marks an unprecedented outbreak of a pandemic named COVID-19 caused by the SARS-CoV-2. It was first discovered in China and later spread to the whole world, currently inflicting almost 200 countries. After China, few other countries have emerged as potential epicenters of this disease including the US, Italy, Spain and Pakistan, as indicated by the World Health Organization (WHO). Since proper preventive and curative measures in the form of a vaccine or medication are currently unavailable throughout the world, the only remedy devised to stop the spread of this virus is self-isolation. Such a measure necessitates ample awareness and understanding among people to avoid actions that lead to the spread of this virus. Pakistan is the fifth-most populous country in the world (212.2 million) and has a record of contagious outbreaks in the past. Therefore, it is key to evaluate the general understanding regarding the cause, spread and control of this disease in Pakistani population and acquire data to anticipate the possible spread and persistence of this disease to design relevant preventive measures. We have attempted to collect such data from professionals who are susceptible to acquiring the infection due to an unavoidable exposure. Keeping in view the current lock down, we have relied on an internet based collection of data by filling a self-designed questionnaire that is responded to by 1132. Descriptive and Frequency Analysis were performed on the responses received using MS Excel and SPSS software. A total of 1132 individuals responded to the questionnaire among which include academic (45.8%), non-academic (20.8%), healthcare (7.8%), security (5.9%) and other (19.7%) professionals. The questionnaire addressed the level of basic information regarding the cause, spread, cure and prevention of this disease among professionals, in an attempt to provide directions for awareness campaigns at different levels in Pakistan and provide a model for similar outbreaks in the future.To our expectations, almost after a month of the coronavirus outbreak in Pakistan, above 50% to up to 90% of the recorded responses against every question showed ample understanding regarding the cause, spread and control of the disease which is an indicator of effective public awareness campaigns throughout the country largely based on media drive.

Impact on the Utilization of Reproductive, Maternal, Newborn and Child Health Care Services at Primary Health Care Level During First Wave of COVID-19 Outbreak in Pakistan.

Introduction: Very little is known and predictable on how long the COVID-19 pandemic will last, even though dramatic preventive measures to flatten the curve and stop its transmission have been taken worldwide periodically since its start. These preventive measures coupled with people’s fear of COVID-19, significantly altered people’s health-seeking behavior and healthcare accessibility. This study aims to measure the impact of the COVID-19 pandemic on the utilization of reproductive, maternal, newborn, and child health (RMNCH) care services at primary health care (PHC) facilities in Pakistan. Methods: A retrospective study was conducted in 22 districts using data from 1169 primary health care facilities. The District Health Information System (DHIS) was used to retrieve district-wise services utilization data from January to April 2020 i.e. January to February 2020 (pre-COVID-19) and March to April 2020 (during COVID-19). The monthly difference (in percentage change) for selected RMNCH services indicators was calculated using the expected number of clients (January to February average) versus the actual number of clients for March and April 2020.Results: We observed a decrease of 12.5% for March and 33% for April 2020 in the total number of clients who availed of primary health care services in Sindh as compared to the pre-COVID-19 monthly average. A decrease in first antenatal care visits (15.6% and 16.3%), delivery coverage (12.8% and 17.9%) and family planning client visits (31.6% and 36.3%) were observed for March and April 2020 respectively. The pentavalent vaccine results revealed a decrease of 19.3% and 63.1%, while a decrease of 17.3% and 54.3% were observed for children receiving the first dose of measles vaccine in March and April, respectively. Conclusions: Our findings show that the number of clients who avail of routine care or RMNCH services at the primary health care level considerably declined during the initial phase of the first wave of the COVID-19 outbreak in Sindh, Pakistan. These results highlight a rising threat to poor RMNCH and outcomes.

The influence of illness perception, anxiety and depression disorders on students mental health during COVID-19 outbreak in Pakistan: a Web-based cross-sectional survey

PurposeSince the emergence of a coronavirus disease (2019-nCoV) in December 2019, the whole world is in a state of chaos. Isolation strategy with quarantine is a useful model in controlling transmission and rapid spread. As a result, people remained at home and disrupted their outside daily activities. It led to the closure of educational institutes, which is a source of many students to cope with numerous personal and familial issues. This study aims to focus on exploring the relationships and potential mediational pathways between mental health problems, illness perception, anxiety and depression disorders.Design/methodology/approachThe study incorporated snowball sampling techniques through a cross-sectional, Web-based survey and recruited 500 students from different universities of twin cities, Rawalpindi and Islamabad from March 23 to April 15, 2020, during the coronavirus outbreak lockdown. The study used four instruments, Beck Depression Scale, Beck Anxiety Inventory, Revised Illness Perception Questionnaire and The Warwick-Edinburgh Mental Well-being Scale for assessing depression, anxiety, illness perception and mental health disorders.FindingsThe findings indicated normal (43.2%), mild (20.5%), moderate (13.6%) and severe (22.7%) levels of anxiety prevalence in students. Results specified a normal (65.9%), mild (9.10%), moderate (9.12%) and severe (15.90%) depression prevalence and findings stipulated that anxiety disorder prevalence was higher than depression disorder. The correlational results specified a negative and significant relationship between mental health, illness perception, anxiety and depression symptoms. The multiple regression analysis stated that anxiety and depression disorders mediated the relationship between mental health and present illness perception. The perception of illness exhibited a relation to depression and anxiety disorders.Originality/valueThe study proposed a model to address mental health problems during the lockdown. The (2019-nCoV) illness perception developed mental disorders, including anxiety and depression, which has declined individuals’ mental health. There is an urgent need for ongoing clinical examination and management to address psychological disorders and findings suggest assessing mental health to combatting the pandemic worldwide. Findings recommend developing strategies to promote mental health-care facilities during COVID-19 wide-ranging disasters. These results highlight the impending importance of devising strategies to treat mental health problems.

Risk Factors of Extensively Drug Resistant Typhoid Fever Among Children in Karachi: Case-Control Study.

BackgroundExtensively drug resistant typhoid fever (XDR-TF) has been responsible for an ongoing outbreak in Pakistan, which began in November 2016.ObjectiveThis study aimed to determine the risk factors associated with XDR-TF.MethodsThis age- and sex-matched case-control study was conducted during May-October 2018 in Karachi. All patients with XDR-TF were identified from the laboratory-based surveillance system data. Cases included patients aged <15 years living in Karachi with culture-positive Salmonella enterica serovar Typhi with resistance to chloramphenicol, ampicillin, trimethoprim/sulfamethoxazole, fluoroquinolones, and third-generation cephalosporins. Age- and sex-matched controls included children free from the symptoms of TF, aged under 15 years, and residing in Karachi. All controls were recruited from among those who attended outpatient clinics.ResultsA total of 75 cases and 75 controls were included in this study. On univariate analysis, the odds of having XDR-TF were 13-fold higher among participants who used piped municipal water than among those who did not (odds ratio [OR] 12.6, 95% CI 4.1-38.6). The use of bore water was significantly associated with XDR-TF (OR 5.1, 95% CI 1.4-19.0). Cases were more likely to report eating French fries with sauce (OR 13.5, 95% CI 3.9-47.0) and poppadum (OR 3.4, 95% CI 1.7-6.7) from street vendors than controls. Boiling water at home was negatively associated with XDR-TF (OR 0.3, 95% CI 0.2-0.7). On multivariate analysis, 2 factors were independently associated with XDR-TF. Using piped municipal water (OR 10.3, 95% CI 3.4-30.4) and eating French fries with sauce from street vendors (OR 8.8, 95% CI 2.1-36.2) were significantly associated with an increased odds of XDR-TF.ConclusionsCommunity water supply and street food eating habits were implicated in the spread of the superbug S typhi outbreak, which continues to grow in Karachi. Therefore, it is recommended to improve the community water supply to meet recommended standards and to develop a policy to improve the safety of street food. In addition, health authorities are required to conduct mass vaccination for TF among high-risk groups.

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

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.

Systematic Review of Reported HIV Outbreaks, Pakistan, 2000-2019.

Abstract Unsafe injection practices and injection drug use have been linked to multiple HIV outbreaks in Pakistan since 2003; however, few studies have systematically analyzed the causes of these outbreaks. We conducted a systematic review of published English-language literature indexed in bibliographic databases and search engines and a focused gray literature review to collate and analyze all reported HIV outbreaks in Pakistan during 2000–2019. Of 774 unique publications reviewed, we identified 25 eligible publications describing 7 outbreaks. More than half occurred during 2016–2019. The primary sources of transmission were iatrogenic transmission, affecting children, persons with chronic medical conditions, and the general population (4 outbreaks); injection drug use (2 outbreaks); and a combination of both (1 outbreak). In the absence of robust HIV testing and surveillance in Pakistan, timely and detailed outbreak reporting is important to understand the epidemiology of HIV in the country.

English

Clostridium perfringens (C. perfringens) is widely distributed in broiler chickens causing clinical and subclinical enteritis and is especially known for causing necrotic enteritis (NE). There are numerous reports of NE outbreaks in Pakistan as well as China but there is a lack of information related to PFGE profile from both the countries. To close this gap, we designed this study and obtained samples from broiler chicken farms located in 3 different regions of Pakistan and 4 different regions of China. A total of 79 fecal swabs (Pakistan=29; China=50) were collected and grown on FTA media. Further, isolates were grown on TSE agar and black colonies were selected for DNA extraction. All 79 isolates were tested for toxin profiles by PCR (α-gene; beta-2; netB gene) and PFGE profiling (pulsotypes analysis). Toxinotyping results revealed that all the isolates (n=50) from China were type A (α-toxin positive) while 23 and 6 isolates (n=29) from Pakistan were type A (α-toxin positive) and type G (α-toxin, NetB positive), respectively. Toxinotyping revealed α-toxin is highly prevalent in both the countries while from Pakistani isolates, NetB toxin was also detected. PFGE discriminated 79 isolates into 45 different PFGE patterns (pulsotypes). The analysis further showed different pulsotypes originating from China and Pakistan and isolates were subtyped by SmaI. The results showed high genetic polymorphism in C. perfringens even within the same strain. These preliminary findings of genetic variations will further help to design control strategies

COVID-19 backlash: psycho-social impacts of outbreak in Pakistan

Purpose: This paper aimed to examine the psycho-social aspects of coronavirus disease 2019 (COVID-19) in Pakistan The study was conducted in Pakistan by using an online survey technique The rationale to opt for this method was mainly based on the country's lock-down situations, social distancing and for the care of respondents Design/methodology/approach: A total of 1,536 individuals participated from different parts of the country An attitudinal scale was administered consisting of statements to measure (dis)agreement of the individuals facing the current situations of COVID-19 The ethical considerations and confidentiality of the respondents were opted by describing the purpose of research on the first page of the questionnaire Findings: The study findings showed that the cost of personal protective equipment (PPE), social isolation and loss of intimacy have favourable positive effects on the psychological problems of individuals through the mediation of fake news and misinformation during COVID-19 Furthermore, the study findings were interpreted as per the effects of current situations of epidemic, i e COVID-19 on the psycho-social life of individuals Research limitations/implications: This paper is purely limited to the quantitative approach including variables, i e COVID-19, risk of infection, social distancing, cost of PPE, social isolation, fake news and psychological problems Practical implications: The present research will enhance the awareness and knowledge regarding psychological problems faced by the individuals during COVID-19 It will be a significant addition to the existing body of knowledge in the field of health and well-being It will also provide guidelines to students, research scholars, policymakers and academicians to develop policies in future to improve the health of people during epidemics such as COVID-19 and similar nature of outbreak in the future Originality/value: This paper focused on an important gap in the research on COVID-19 in the country in the context of COVID-19, risk of infection, social distancing, cost of PPE, social isolation, fake news and psychological problems © 2021, Emerald Publishing Limited

Comprehensive evaluation of wheat operation during COVID-19 outbreak in Pakistan.

The whole world is confronting under extreme danger from COVID-19 pandemic. Which spread rapidly including an agro-based developing state like Pakistan. Right now this year "Rabi" crop season has safely ended during this pandemic. Wheat-crop operations are depended on environmental conditions and different operational safety measures. Farmworkers are the key individuals, as they are exposed to various environmental, health, safety, biological, and respiratory hazards. Due to COVID-19, there are about more than three thousand (3000) mortalities and one hundred eight thousand (18, 0000) plus persons have been effected, however this number increases further rapidly. The key purpose of this review-study is to highlight the timely adopted safe strategies and their impacts on the yield of wheat along with farmworkers under some Standard Operational Procedures (SOPs) during wheat operations, enabling food security, self-sustainably and securing of farmers in the context of COVID-19. Various actions have been taken worldwide, but a developing state like Pakistan with minimum resources, has made well-organized planning and strategies to sustain the production of wheat with public awareness. We highlighting government efforts to-combat this fatal pandemic, where it has directly impacted the crop yield and also the economy of the state. Whereas, especially during this period, uplifting of economy through agriculture sector, needs to overcome the same management deficiencies from other sectors. Pakistani Government has adopted and implemented different key steps for fighting against COVID-19 include: i. Government command along with incentive approach, ii. Mutual coordination among stakeholders, local governments, and farmers, iii. Continuous inspection setup, and iv. Provide adequate personal protective equipment (PPE).