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WHO EMRO Weekly Epidemiological Monitor: Volume 14; Issue no 46; 14 November 2021

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Situation Report
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Current major event

Upsurge of dengue cases in Pakistan, 2021

The Ministry of National Health Services, Regulations and Coordination in Pakistan observed an upsurge of dengue fever cases in the past weeks. The upsurge started in week 32 where an increase in number of cases was reported from different provinces in Pakistan reaching its peak on week 40. Health authorities intensified their response activities to contain this upsurge of cases and to control and prevent its spread to other communities or neighbouring countries.

Editorial note

Dengue is endemic to Pakistan as the main vector of dengue virus transmission, Aedes aegypti, is well established in all parts of the country. The first outbreak of dengue fever was reported in Karachi (Sindh province) in 1994. Since then, the country has experienced several outbreaks in different provinces. The biggest outbreak the country faced so far was in 2011 in Lahore (Punjab province) immediately after the floods of 2010. Over 550 000 suspected/clinically diagnosed cases were reported during that outbreak.

As of 11 November 2021, Pakistan has reported total of 236 773 suspected dengue cases and 197 associated deaths. The total lab confirmed cases are 38 378. Punjab province reported the highest number of confirmed cases (43%) followed by Khyber Pakhtunkhwa, Sindh and Balochistan (see table).

Most of the deaths were reported from Punjab (72.5%) where the district of Lahore reported 101 deaths (51% of the cases in the country).

The upsurge of cases was observed from week 32 of this year. It reached a peak during week 40, where a total 12 450 confirmed cases were reported (see graph). In week 44, cases started declining to 5439 confirmed cases across the country. In week 44, Punjab province reported the highest number of confirmed cases (2815), followed by Khyber Pakhtunkhwa (1453), Islamabad (ICT) (637), Sindh (487), Azad Jammu and Kashmir (324), and Balochistan (47).

Vector control and environmental management response activities were intensified in most of the affected districts or communities. Aedes larvae surveillance and sweeping activities are ongoing with a focus on hotspot areas in different districts. Aedes larvae indices (overall house and containers indices) are being monitored. Selective indoor residual spraying, larvae source inspections and management, and space spraying in some hotspots were intensified.

WHO supported the government with the provision of case diagnosis and management guidelines and capacity building among frontline health workers throughout the country. Information, education and communication materials were distributed to raise the awareness of the general public on prevention measures to reduce risks.

Despite the ongoing efforts to control and prevent dengue fever in Pakistan, several gaps still remain. Efforts should be directed towards strengthening the provision of essential care and increasing hospital capacities to manage cases especially at the district level, which is overwhelmed by the COVID-19 pandemic. Multi-sectorial collaboration should also be scaled up, along with the engagement of communities, national nongovernmental institutions, academia and the private sector.