Outbreak In Pakistan Research Articles

Prevalence of dengue virus in Haripur district, Khyber Pakhtunkhwa, Pakistan

Dengue virus (DENV) has caused about 12 large outbreaks in Pakistan, resulting in 286,262 morbidities and 1108 deaths. The most affected province is Khyber Pakhtunkhwa (KP). This study was conducted to determine the average DENV prevalence in different areas of the Haripur endemic district of KP and the causing factors of DENV. MethodsThis work was a cross-sectional study that was performed in the DENV endemic district Haripur. A total of 761 individuals were included in this study. The data were categorized according to sex, age and symptoms (like fever, body aches, bleeding, and skin rash). For data analysis, SPSS 23 version was applied. ArcGIS version 10.8 was used to map the study area. ResultsIn this study, there were 716 confirmed cases of DENV fever, including 421 males (58.8%) and 295 females (41.2%). The most affected age range, 16–30 years, reported by 301 (42.0%), was followed by 31–45 years, 184 (25.7%), above 46 years, 132 (18.4%), and 0–15 years, 99 (13.8%). The positive IgG cases were 581(81.0%). Those whose age ranges from 1 to 15 years 82 (8.7%) cases, 16–30 years 244 (34.1%), 31–45 years 156 (21.8%), above 46-year age 99 (13.8%) cases. In addition, this suggests that those between the ages of 16 and 30 are at the highest risk for DENV infection. However, this might be the fact that individuals in this age range are more likely to be out in the environment, making them more vulnerable to the virus. ConclusionOver the past ten years, DENV fever has become increasingly prevalent in Pakistan. The risk is substantially higher for males. Dengue outbreaks hit those between the ages of 16 and 30 the hardest. The proper monitoring and assessment of DENV are necessary for prevention and controlling the disease. Disease surveillance includes identification and molecular characterization of infected persons and monitoring mosquito populations in high-risk locations for the purpose of vector surveillance. In order to assess the community's willingness to participate in DENV preventive efforts, behavioral impact surveillance is also necessary.

The Economic Impact of Lumpy Skin Disease and Cost-Effectiveness of Vaccination for the Control of Outbreaks in Pakistan

Lumpy Skin Disease (LSD) may cause major financial damage to farmers. It is a significant barrier to global trade. The Lumpy Skin Disease Virus (LSDV) is a member of the Capri poxvirus genus. The LSD significantly reduces milk production, which might drop from 10 percent to 85%. Consumption of milk and meat has decreased by 60percent to 70percent in Karachi (Pakistan) as a result of LSD usage. Cattle of all species and ages are affected, although lactating cows and young cattle are more at risk. Most LSD outbreaks take place in hot, humid environments when most of the flies that contribute as vectors are present. LSD might be transmitted more quickly by animals. While death is typically low (between 0 and 7%), morbidity ranges from 0.75 to 100%. Lesions can be seen in the reproductive, respiratory, and digestive system tissues. Mastitis, pneumonia, infections of the skin, limping, diarrhea, and myiasis are possible secondary consequences of severe LSD. Consuming milk and meat from diseased animals is dependable and safe. It is vital to choose infection control and preventive techniques. One of the main ways that LSD is spread in areas where it is not endemic is through the restricted mobility of infected animals. Another suggestion for disease control is to reduce the number of insects and vectors. Furthermore, the most effective method for disease control may involve vaccination or immunization with the homologous strain of the LSDV. For control measures to be chosen in time for the LSD to be reduced, diagnosis is therefore of utmost importance and should be rapid and accurate, particularly in endemic regions.

Hematological and Biochemical Assessment of Children Infected with Measles Virus: 2022 Outbreak in Pakistan

Measles is a contagious disease caused by an RNA virus. Resurgence of measles after Covid-19 and its severity among children has led to many speculations about the Measles vaccination coverage and its efficacy. In this study, the clinical data of children <9 years (n=19) admitted at the Pakistan Institute of Medical Sciences (PIMS) in the measles ward was analyzed. The blood samples were processed for hematology and routine biochemistry tests. The results obtained were statistically analyzed on SPSS-21 software by using One-Way ANOVA for Complete Parameters (CP), Kruskal Wallis, and Mann-Whitney test for Differential leucocyte count (DLC) and Biochemical parameters. A p<0.05 was considered significant. The results suggest no significant difference in Complete blood parameters (CP) among non-vaccinated, partially vaccinated and fully vaccinated patients. Among DLC Basophils level was significantly different (p=0.024), being lower in partially vaccinated than non-vaccinated patients. Biochemical parameters showed that serum urea level was significantly different (p=0.013), showing a decline in fully vaccinated patients as compared to non-vaccinated patients. Moreover, a significantly higher level of Alkaline phosphatase as compared to the normal range was observed in fully vaccinated patients. However, lower levels of MCH, MCV, MCHC, RBC, Hb, eosinophils, and a higher level of RDW-CV were observed overall as compared to the normal range (healthy individuals). The results suggest improvements are needed in vaccination strategies for effectively controlling the disease. Anemic conditions in overall measles patients indicate poor health conditions. This study contains a limited sample size, further research on measles virus (MeV) mutations, and vaccine optimization could be helpful for the complete eradication of measles from Pakistan.

Genomic Characterization of Dengue Virus Outbreak in 2022 from Pakistan.

Pakistan, a dengue-endemic country, has encountered several outbreaks during the past decade. The current study aimed to explore the serotype and genomic diversity of dengue virus responsible for the 2022 outbreak in Pakistan. From August to October 2022, NS-1 positive blood samples (n = 343) were collected from dengue patients, among which, (85%; n = 293) were positive based on RT-PCR. In terms of gender and age, dengue infection was more prevalent in male patients (63%; n = 184), with more adults (21-30 years; n = 94) being infected. The serotyping results revealed DENV-2 to be the most predominant serotype (62%; n = 183), followed by DENV-1 (37%; n = 109) and DENV-3 (0.32%; n = 1). Moreover, a total of 10 samples (DENV-2; n = 8, DENV-1; n = 2) were subjected to whole-genome sequencing. Among these, four were collected in early 2022, and six were collected between August and October 2022. Phylogenetic analysis of DENV-2 sequenced samples (n = 8) revealed a monophyletic clade of cosmopolitan genotype IVA, which is closely related to sequences from China and Singapore 2018, and DENV-1 samples (n = 2) show genotype III, which is closely related to Pakistan isolates from 2019. We also reported the first whole genome sequence of a coinfection case (DENV1-DENV2) in Pakistan detected through a meta-genome approach. Thus, dengue virus dynamics reported in the current study warrant large-scale genomic surveillance to better respond to future outbreaks.

Monsoon and cholera outbreaks in Pakistan: a public health concern during a climate catastrophe

Monsoon and cholera outbreaks in Pakistan: a public health concern during a climate catastrophe

Dengue Outbreak in Pakistan: Impact on Global Mass Gathering Events?

Abstract

COVID-19 and Psychological Complications Among University Students in Islamabad: A Cross-sectional Survey

Background: Due to quarantine, mental health problems particularly depression and anxiety worsen in the general population. The psychological impact of COVID-19 on university students is more due to exaggerated stress levels and anxiety-related evidence as a result of transformed delivery and doubtfulness of university education, technological concerns of online courses of instruction, being far away from home, social separation and financial losses. Objective: To determine the post-COVID-19 psychological complications among university students in Islamabad. Methods: The study was carried out in various educational universities in Islamabad from March to August 2021. A questionnaire was distributed to obtain data about demographic characteristics and psychological complications during quarantine periods after the Covid-19 outbreak in Pakistan. The questionnaire used to collect data was DASS 21 questionnaire. The association between quarantine due to COVID-19 and students' psychological health was estimated through SPSS 23 analysis procedure with a p-value<0.001 Results: The study was completed by participation of 219 individuals, 54(24.7%) females and 165(75.3%) males. All students with age between 18-30 years who completed the questionnaire both physically and online. The results of the cross-sectional study showed that depression p-value=0.30, anxiety p=0.03 and stress p=0.01. Conclusion: The incidence of post-COVID-19 quarantine psychological complications was quite high among university students of Islamabad due to home-based and administrative quarantine during lockdown measures for conserving their physical and mental health and daily life activities. The current study concludes that stress, anxiety and depression were quite common in students of universities due to quarantine.

Evolutionary dynamics of topotype ME-SA/Ind-2001 of foot and mouth disease virus serotype-O in Pakistan: 2017-2022.

During past few years, the Ind-2001 lineage of the Middle East-South Asia topotype (ME-SA) of the foot-and-mouth disease (FMD) virus has been implicated in FMD outbreaks in Pakistan. This work conducts a comprehensive evolutionary analysis of the Ind-2001 and Pan Asia II lineages, with a specific emphasis on their geographical distribution, lineage classification, and sub-lineage distribution within the region. Furthermore, it aims to expand our understanding of the conserved region of the VP1 protein. Total samples (n=50) were subjected to antigen detection ELISA and RT-PCR for serotype determination. Confirmed serotype-O isolates (n=17) underwent sequencing for lineage comparison, mutation impact assessment on the VP1 protein GH loop, 3D structure prediction, and further comparative analysis. Isolates collected from 2017 to 2020 were identified as serotypes O/ME-SA/Pan Asia II ANT10 and O/ME-SA/Pak14. Notably, isolates collected from 2020 to 2022 belonged to a novel FMDV serotype O/ME-SA/Ind-2001e lineage. Phylogenetic analyses indicated that these strains were distinct from dominant contemporaneous strains which may challenge Pakistan's FMD control measures. These isolates exhibited variance in the VP1 epitope, specifically in amino acid residues 135-155, known to influence neutralizing antibody generation. Observed mutations suggest potential challenges to current vaccination efficacy against FMD. This emphasizes enhanced FMD surveillance and demonstrates that tracking the emergence of the O/ME-SA/Ind-2001e lineage is important for determining FMD control strategies in Asia.

Crimean-Congo hemorrhagic fever outbreak in Pakistan, 2022: A warning bell amidst unprecedented floods and COVID 19 pandemic.

Crimean-Congo hemorrhagic fever (CCHF) is an infection caused by a tick-borne virus (genus: Nairovirus, family: Bunyaviridae). The most important vector for CCHF is the ixodid tick. Along with tick bite, direct contact with the virus-affected animal is responsible for its spread. Pakistan witnessed its first case of CCHF in 1976 and has been a major victim of CCHF for years, but spikes in cases are seen after Eid-ul-Adha, an Islamic festival involving the sacrifice of cattle. The disease, in particular, is common among butchers, veterinarians, and livestock workers. From the start of this year till June 22, 2022, a total of four cases have been reported across the country. Pakistan faces major challenges in combating CCHF every year due to its specific geographical position and a majority of the population being involved with animal husbandry. There is no approved vaccine for its prevention. All these factors contribute to the burden on the already weakened healthcare system of Pakistan. Strict actions should be taken to contain the spread of the disease. The need of the hour is to engage the general population, raise awareness, and develop policies to ensure disease surveillance. This should be accompanied by fostering collaboration among animal and human health departments for efficient communication and early intervention. The focus should be on medical research to find an efficacious treatment and prophylaxis for the CCHF virus, which will be the cornerstone of future CCHF prevention and control strategies.

Engineering Modified mRNA-Based Vaccine against Dengue Virus Using Computational and Reverse Vaccinology Approaches.

Dengue virus belonging to the family Flaviviridae and its four serotypes are responsible for dengue infections, which extend over 60 countries in tropical and subtropical areas of the world including Pakistan. During the ongoing dengue outbreak in Pakistan (2022), over 30,000 cases have been reported, and over 70 lives have been lost. The only commercialized vaccine against DENV, Dengvaxia, cannot be administered as a prophylactic measure to cure this infection due to various complications. Using machine learning and reverse vaccinology approaches, this study was designed to develop a tetravalent modified nucleotide mRNA vaccine using NS1, prM, and EIII sequences of dengue virus from Pakistani isolates. Based on high antigenicity, non-allergenicity, and toxicity profiling, B-cell epitope, cytotoxic T lymphocyte (CTL), and helper T lymphocyte (HTL) putative vaccine targets were predicted. Molecular docking confirmed favorable interactions between T-cell epitopes and their respective HLA alleles, while normal mode analysis validated high-affinity interactions of vaccine proteins with immune receptors. In silico immune simulations confirmed adequate immune responses to eliminate the antigen and generate memory. Codon optimization, physicochemical features, nucleotide modifications, and suitable vector availability further ensured better antigen expression and adaptive immune responses. We predict that this vaccine construct may prove to be a good vaccinal candidate against dengue virus in vitro as well.

Monkeypox virus: A potential concern for Pakistan?

Dear Madam, the sudden emergence of the monkeypox virus occurred in 1970, after which it firmly anchored its roots in 11 countries in the African region. The virus belongs to the same genus as the variola and cowpox virus, the Orthopoxvirus.(1) Monkeypox is not as virulent as smallpox and usually clears up on its own without treatment, with symptoms occurring over 2-4 weeks. The disease ensues following viral entry via pharyngeal and intradermal routes, after which it spreads from the site of entry to local lymph nodes. (2)The infective period is classified into an invasive period which is typified by swelling of lymph nodes, severe anaesthesia, and headache lasting for 5 days; and the second period marked by dermatitis lasting for three days. However, monkeypox does not spread easily from person to person. Wearing clothes worn by someone else, sexual contact with an infected person, inhalation of contaminated droplets, and close contact with open wounds can eventually transmit the virus from one person to another.(1) Currently, there has been an outbreak of the monkeypox virus with nearly 200 cases being reported in more than 20 countries, the majority of which are non-African with Europe being the epicenter of this outbreak. The fact that monkeypox is detected in people with no apparent connection to one another and that a significant number of cases are being reported in homosexual men has been alarming.(3)Although no case of monkeypox is reported yet in Pakistan, NIH has placed Pakistan on high alert against the virus in light of cases being reported in non-endemic countries. Pakistan lacks facilities for diagnostic tests for the virus. However, efforts are being made to forestall an outbreak with arrangements made to screen the inbound passengers and declare a patient “suspected” based on their symptoms until proper diagnostic kits arrive in the country.(4) Vaccina vaccine, which proved to be the cornerstone in eradicating the smallpox virus, offered a coincidental immunity against monkeypox too. However, smallpox was termed eradicated in 1980 and the subsequent cessation of the smallpox vaccine means the supply of these vaccines is scarce. Current treatment for monkeypox include the use of antivirals such as Tecovirimat and Brincidofovir; (5) and the use of FDA approved attenuated live virus vaccine, the JYNNEOSTM.(1) The need of the hour deems it imperative that we as a community work in unison to prevent an outbreak in Pakistan. ---Continue

Frequency of Common Neurological Manifestations among Patients Presenting with Human Immunodeficiency Virus Positivity

Background: Unsafe injection practices and injection drug use have been linked to multiple HIV outbreaks in Pakistan since 2003.HIV/AIDS has a wide range of clinical manifestations, and it affects a variety of organ systems. It is neuro-invasive, neurotropic and neurovirulent, and can directly induce nervous system diseases due to its preference for the nervous system.Objective: To determine the frequency of common neurological symptoms in patients who have tested positive for the human immunodeficiency virus.Material and Methods: This descriptive cross-sectional study was conducted on 131 patients for 6 months in the Department of Medicine, Lady Reading Hospital, Peshawar (9/7/2019 to 8/1/2020). Routine examinations, CSF cultures, monofilament tests, detailed histories, and ICD-9 criteria inspection were performed on all patients to detect the existence of common neurological symptoms such as TBM, cryptococcal meningitis, peripheral neuropathy, headache, seizures, and dementia. A pre-designed proforma was used to record the data. The data was analyzed us SPSS version 20. Results: The current study showed that 66% of the patients were men and 34% were women with a mean age of 36±10.51 years. Mean duration of the disease was 1±7.33 years. TBM (45%), cryptococcal meningitis (15%), peripheral neuropathy (16%), headache (26%), seizures (28%), and dementia were the most common neurological symptoms (5%).Conclusion: TBM (45%), cryptococcal meningitis (15%), peripheral neuropathy (16%), headache (26%), seizures (28%), and dementia (5%) were the most prevalent neurological symptoms in patients with human immunodeficiency virus positive, according to our findings.Key Words: Neurological manifestations, HIV /AIDS infection.

Extensively Drug-Resistant Typhoid Outbreak in Pakistan, Experience at a Tertiary Care Hospital in Lahore; A Tip of An Iceberg

Objective: To provide a laboratory-based surveillance report of typhoid fever cases diagnosed at a tertiary care hospital in Lahore during the ongoing outbreak.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Department of Microbiology, Combined Military Hospital, Lahore Pakistan, from Mar 2018 to Jun 2019.
 Methodology: All positive blood culture samples that yielded the growth of Salmonella Typhi were included in the study. The samples were dealt with according to standard microbiological procedures. Antimicrobial susceptibility was performed using Clinical and Laboratory Standards Institute (CLSI) guidelines.
 Results: During the study period, (377) Typhoidal Salmonellae were isolated, of which 327 (86.7%) were Salmonella Typhi and 50 (13.3%) were Paratyphi A. The percentage of XDR Salmonella isolates was 41.9%.
 Conclusion: Extensively drug-resistant typhoid fever cases reported in this study represent just the tip of an iceberg. Therefore, nationwide surveillance efforts must be undertaken along with implementing effective preventive measures.

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.

BackgroundDengue 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.MethodThis 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.ResultsPeshawar 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.ConclusionMultiple 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.

Unassigned Complex Unique Recombinant Forms Related to CRF36_cpx in Children Identified in an HIV-1 Outbreak in Pakistan.

In 2019, an outbreak of HIV infection predominantly affecting children occurred in Larkana district, Pakistan. This is the largest outbreak ever reported in this age group in Pakistan. In this study, we report two HIV-1 unique recombinant forms identified during the outbreak. Blood samples were collected from HIV-positive children as part of a case-control study to investigate the outbreak. The pol gene was sequenced and used to detect HIV subtype/recombinant forms using subtype, recombination, and phylogenetic analyses. Drug resistance mutation (DRM) analysis was performed to characterize the DRMs in each sequence. We observed the emergence of two unassigned unique recombinant forms related to CRF36_cpx in 15 individuals of the 344 samples collected. Genotype analysis revealed the presence of multiple DRMs associated with resistance to reverse transcriptase inhibitors. The discovery of these unassigned unique recombinant forms in our population highlights the need for comprehensive molecular epidemiological studies to fully understand the distribution and drug resistance patterns to aid control efforts.

Foot-and-Mouth Disease Virus Serotypes O and A from Outbreaks in Pakistan 2011-2012.

ABSTRACTWe report the near full genome sequences of 18 isolates of foot-and-mouth disease virus serotype O and 6 isolates of serotype A obtained from outbreaks in Pakistan between 2011 and 2012. The scarcity of full-length FMDV sequences from this region enhances the importance of these genomes for understanding regional molecular epidemiology.

Cholera: A deadly but unnoticed outbreak in Pakistan

Cholera: A deadly but unnoticed outbreak in Pakistan

A memory effect model to predict COVID-19: analysis and simulation

On 19 September 2020, the Centers for Disease Control and Prevention (CDC) recommended that asymptomatic individuals, those who have close contact with infected person, be tested. Also, American society for biological clinical comments on testing of asymptomatic individuals. So, we proposed a new mathematical model for evaluating the population-level impact of contact rates (social-distancing) and the rate at which asymptomatic people are hospitalized (isolated) following testing due to close contact with documented infected people. The model is a deterministic system of nonlinear differential equations that is fitted and parameterized by least square curve fitting using COVID-19 pandemic data of Pakistan from 1 October 2020 to 30 April 2021. The fractional derivative is used to understand the biological process with crossover behavior and memory effect. The reproduction number and conditions for asymptotic stability are derived diligently. The most common non-integer Caputo derivative is used for deeper analysis and transmission dynamics of COVID-19 infection. The fractional-order Adams–Bashforth method is used for the solution of the model. In light of the dynamics of the COVID-19 outbreak in Pakistan, non-pharmaceutical interventions (NPIs) in terms of social distancing and isolation are being investigated. The reduction in the baseline value of contact rates and enhancement in hospitalization rate of symptomatic can lead the elimination of the pandemic.

Multiple Genome Sequences of Foot-and-Mouth Disease Virus Asia-1 Lineage Sindh-08 from Outbreaks in Pakistan, 2011 to 2012.

ABSTRACTWe report the near-full-length genome sequences of 22 isolates of foot-and-mouth disease virus (FMDV) serotype Asia-1, lineage Sindh-08, obtained from foot-and-mouth disease outbreaks in Pakistan between 2011 and 2012. The scarcity of full-length FMDV sequences from this region enhances the importance of these new genomes for understanding the regional molecular epidemiology.

Impact of the Covid-19 Outbreak on the Dental Profession in Pakistan

The COVID-19 outbreak has affected dentists all over the world, including those in the Pakistan. It has had a huge impact on the practice of dental professionals as they are in direct contact with oral and nasal secretions of patients in the field. We conducted this study to find out how dental practitioners felt about the outbreak and how they believed it will affect the dental profession. To assess the impact of COVID-19 outbreak in Pakistan an exploratory cross-sectional study of dental professionals was conducted. Self-administered questionnaires were distributed to consenting participants between October and December 2021 via an online data collection platform (Google forms). These questionnaires were to collect the data about the understanding and awareness about the pandemics impact on respondent’s sociodemo graphics and psychological health. The data analysis in this study was done using the Statistical Package for the Social Sciences (SPSS) version 20. The study included 118 dental practitioners from the Pakistan, with an average age of 39.25 years and a majority of the participants were males. COVID 19 was determined to be well-understood by nearly 91 (77.1 %) respondents. COVID-19 was of the grave concern for more than half of the participants, 64 (54.24%), with the danger of catching the virus in the dentistry clinic being the most concerning cause of concern 64 (54.24%). It is concluded that the dental practitioners had an excellent awareness about the epidemiology, diagnosis, prevention, and treatment of COVID-19. Keywords: COVID-19, Pneumonia, Dental, Awareness, Psychology