Lahore's Dengue outbreak in 2011

Almost two hundred dengue cases have been recently reported in Lahore, in a second and more intense wave this year. The epidemic is expected to continue through September and October, monsoon months which are most conducive to mosquito breeding. The threat is higher in northern Lahore and walled city where water pools, leaking pipes and congested areas serve as safe havens for mosquito vectors. 

Pakistan's Swine Flu threat in 2011

Swine influenza is an infection of the respiratory tract caused by a type of virus that is endemic and and meat processing workers.

common in pigs worldwide. Influenza A causes acute sickness and serious complications sometimes leading to death. The flu is transmitted from an infected animal to an uninfected animal through direct contact and can increase through intensive farming. People who work with poultry or swine are at an increased risk, such as cattle farmers, veterinarians

The symptoms of the disease include fever, sore throat, runny nose, lethargy, pressure in chest, rapid breathing, bluish or grey skin colour, low blood pressure due to dehydration, no desire of liquid intake, dizziness and confusion, very high body temperature and respiratory failure, lack of appetite, coughing, nausea, vomiting and diarrhea. The virus is spread through migrants and is extremely transmittable. The symptoms are comparable to the common flu and therefore often create confusion in diagnosis.

According to National Institute of Health (NIH), some 85 people have been tested positive for H1N1 virus this winter. There are four basic subtypes of this flu -- H3N2, H3N1, H1N2, and H1N1. January is the peak season for this infection. However, the NIH officials believe the situation is under control.

Maximum numbers of cases have been reported in Punjab (28), followed by Sindh (19) and KP (10). The H1N1 virus does not survive cooking temperatures of 71ºC or more. Nonetheless, like all other viruses it can adapt to different environments, evolving through gene modification.

H1N1 is the same strain which causes the common cold but the latest version has evolved into a wholly human disease now, which can spread among people through coughing and sneezing. Over-crowding, moving in public places and sharing a room with many family members increase the risk.

"A wave of fear has gripped people and even a slight temperature and flu causes the fear of swine flu," says Dr Rizwan Qazi, a senior physician at Pakistan Institute of Medical Sciences (PIMS) in Islamabad.

Two patients of swine flu, including a female in her 30s, have been under treatment in the Isolation Ward of PIMS.

Sindh Health Minister Dr. Sagheer Ahmed had recently inaugurated the Sentinel Influenza Surveillance Laboratory and the Medical Out-Patient Department at Civil Hospital Karachi (CHK) with the help of international donor agencies. The centre will provide treatment for viral diseases in the province, including swine flu. It has a special H1N1 Surveillance Cell. Dr. Sagheer Ahmed had promised to activate the lab and give accurate results, but conceded that natural disasters like the recent floods have taken a toll on the national exchequer leaving little to be spent on health and development.

"According to international recommendations, we are required to closely watch the behaviour of the virus. For laboratory-based surveillance of seasonal influenza virus, Pakistan has a robust laboratory network consisting of an apex laboratory at NIH, as well as one laboratory each at King Edward Medical College, Lahore, Civil Hospital, Karachi, Bolan Medical College, Quetta and Hayatabad Medical Complex, Peshawar. Two more laboratories will be set up in Gilgit and Muzaffarabad in collaboration with the Centres for Diseases Control, Atlanta," says Executive Director of NIH Dr. Birjees Mazhar Qazi.

Children, pregnant women, old and those who are already ill are more vulnerable. It is, therefore, important for health departments of all the provinces to run public awareness campaigns, especially for the vulnerable groups, which deal with animal farming.

"During the high transmission season, samples will be collected from the OPDs of hospitals under standardised SOPs to determine the range of the circulating influenza virus. It will also enable us to study the characteristics of last year’s pandemic strain and to detect any possible changes," adds Dr. Qazi. "Vaccination is an important tool for self-protection. Seasonal flu vaccine is now available in Pakistan."

Fluarix, a vaccine, has been dubbed to protect people for almost a year and costs Rs500 to 600. Acetaminophen, a five-day course of anti-viral is also prescribed. It costs Rs2000 per course.

Health officials need to be deployed at international airports, seaports and border posts to screen suspected patients, install thermal scanners and provide pre-pandemic vaccine at hospitals. Children and adults with flu symptoms should refrain from attending educational institutes.

Expensive swine flu scanners were placed in Pakistan’s major airports but most of them are not working now. Isolation wards need to be set up and vaccines need to be stored in bulk in all major hospitals across Pakistan.

There is no cure for swine flu, only precaution. The swine flu can be prevented by improved hygiene, avoiding contact with flu patients and coughing animals.

This piece was first published in The News. 

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You might have read the news that Crimean–Congo hemorrhagic fever (CCHF) or Congo virus cases have emerged in Pakistan.

There is news of the virus spreading further up north, to Punjab.