A SENSE of “imminent doom”, “exhaustion”, “head confused”, “semi-conscious state of sleep”, accompanied by fever, nausea, vomiting and excruciating body pain, it is so dengue survivors describe this flu-like illness, which can also be fatal.

To think that a small vector – the mosquito – can wreak so much destruction on the physical and mental state of a human being is indeed overwhelming.

Of the three species that spread dengue fever in Pakistan, Aedes aegypti and Aedes albopictus have been around for several years, but the outbreak of Aedes vitatus has been reported in Islamabad for the very first time.

Multiple vectors existing in multiple habitats and with diverse behaviors will pose a challenge to control strategies, explained Ijaz Ali, professor of virology in the Department of Biosciences at Comsats University Islamabad. Sanitizing the city, not letting water stagnate and larviciding bodies of water with temephos, a chemical recommended by the WHO and to which the mosquito has not yet developed resistance, are an integral part of the fight against dengue.

It is the epidemic of malaria, particularly in flood-affected areas of Sindh, that is of greatest concern.

Climate change, a population of tracks, urbanization and an increase in travel and transport are further fueling the disease, and the vector has now adapted comfortably to conditions in cooler parts of Pakistan.

First reported in 1994, it was not until 2005 that an epidemic-like situation was observed in Karachi; by 2010, it had spread to KP and Punjab. In 2016, Balochistan and AJK were also reporting cases of dengue fever.

In Islamabad this year, more than 2,000 cases have been reported with at least six deaths; in KP, the number exceeds 6,000 with at least nine deaths; Punjab has reported more than 5,000 cases, including at least eight deaths. (Lahore alone has reported more than 2,000 cases.) In Sindh, so far this year, more than 9,400 people have tested positive (nearly 7,000 in September alone); at least 38 people are believed to have died, including 35 in Karachi alone.

Although this year’s surge in dengue cases in urban centers can be attributed to unprecedented rainfall – and the government’s lack of preparedness, despite knowing that monsoons are an annual phenomenon – it is the epidemic malaria, especially in flood-affected areas of Sindh. parties, which is of more concern to infectious disease specialist Dr. Sunil Dodani of Sindh Institute of Urology and Transplantation, Karachi (SIUT).

Malaria, transmitted by the bite of an infectious female Anopheles mosquito, has been around for years and gets less attention than dengue, although the symptoms of the two are more or less the same and only a blood test can tell the difference. first of the second.

Editorial: Dengue Concerns

The WHO reported 241 million cases worldwide in 2020. In addition to high fever, chills and sweating, symptoms may include nausea, headache, diarrhea, fatigue, body aches, kidney failure, seizures and confusion. In severe cases, it can even lead to coma.

Dengue generally runs its seven-day course, after which, in the majority of cases, the person recovers; but if malaria is left untreated, it can prove fatal, according to Dr Khalid Qumbrani, director of public health at the Balochistan provincial health directorate. The death toll from malaria in the province has reached 20, he said.

SIUT teams screening patients for both dengue fever and malaria, in flood-affected parts of Sindh, especially the more remote areas where the institute’s teams are providing health care, said that 50% of the tests were positive for malaria, while only 1 pc was positive for dengue fever. Dr Dodani said the malaria outbreak continues to remain under the radar, although it has been reported in large numbers in remote villages in Sindh.

Dr Muhammad Juman Bahoto, Director General of Sindh Health Services, said up to 5,000 people contract malaria every day. However, of the total number of people screened for malaria, only 20-24% are positive. But bodies of standing water continue to pose a “serious” danger as malaria cases increase, and “the magnitude may continue to increase”, he added.

The discoveries of Balochistan are also serious. Over the past fortnight, the positivity rate for malaria was 50%. Just over 51,000 cases of malaria, out of 100,000 people screened, have been reported in different districts, the Balochistan doctor said. Luckily for the province, people in 26 (out of its 34 districts) where malaria is endemic, not only benefit from free testing, but also free treatment thanks to the Global Fund (established to defeat HIV, tuberculosis and malaria) and WHO.

With only eight districts currently receiving support from the Global Fund, the Sindh government has reached out to the Global Fund to include all districts, given the increase in malaria cases due to the floods.

Dr Dodani, however, predicted that dengue fever numbers would drop over the next two weeks as the weather cools and freshwater pools dry up. But, he said, malaria will continue to rise at a frightening scale if left untreated, as the standing water is unlikely to recede any time soon.

Of the two common species of malaria – Plasmodium vivax and Plasmodium falciparum – the latter is more severe, according to infectious disease specialist Dr Naseem Salahuddin at Indus Hospital in Karachi. Already between four and five patients from the interior of Sindh are referred to SIUT every day with kidney failure or brain damage from cerebral malaria, Dr Dodani said, and are “less likely to survive”.

And that’s why the 650,000 pregnant women affected by the floods are a big concern for health care providers. According to Dr. Salahuddin, if they are not diagnosed and therefore untreated for vector-borne diseases, they can develop complications and give birth prematurely or miscarry. There may also be cases where the mother and her unborn child die.

With a huge volume of standing water in many districts of Sindh, medicated bed nets to ward off mosquito swarms in short supply and a looming shortage of chloroquine (although Dr Bahoto said the Sindh government has over 800 000 antimalarial drugs and for the government to buy more if needed), experts wonder whether administering mass malaria prophylaxis would be a simpler solution. The downside however – the development of drug resistance – remains a formidable concern.

The author is a freelance journalist based in Karachi.
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Twitter: @Zofeen28

Posted in Dawn, October 1, 2022