Pakistan has been experiencing a continuous rise in the incidence of Crimean Congo Haemorrhagic Fever (CCHF). Sporadic cases of CCHF are reported from rural areas of Punjab, Azad Jammu Kashmir and Khyber Pakhtunkhwa and neighbouring Afghanistan where cattle herding is common. The objective of this paper was to describe the epidemiology of CCHF. A descriptive study was carried out in the CCHF isolation ward in Islamabad in a tertiary care hospital from February to November 2018. Using a standardised case definition, all patients admitted in the isolation ward with clinical evidence of CCHF were included in the study. After taking the informed consent, data were collected on demographic factors, history of animal contact, tick-bite history, co-morbidity, laboratory results and treatment outcome. Data were analysed as per time, place and person. During the study period, 40 suspected CCHF patients were admitted in the isolation ward, 32 (80%) males were affected. Mean age of the cases was 33.5 years (range 13-70 years). Most affected 17 (42.5%) age group was 20-29 years. Animal contact history was found in Thirty-seven (92.5%) of cases and 28 (70%) with tick bites. Most of the cases, 26 (65%), were reported from July to August. Forty patients in this study were tested by Real Time Polymerase Chain Reaction (PCR), 20 (50%) were positive, out of which 6(30%) expired. Majority of the positive patients were animal handlers by occupation (37.5%). Proper personal protective equipment was available. The reference laboratory facility was not available for immediate investigations was sent to National Institute of Health for confirmation. The overall results show the important risk factors for CCHF a history of tick bites, high-risk occupations and having contact with livestock. Public health measures should focus on preventing tick bites, increasing awareness of CCHF signs and symptoms, timely investigation, and treatment to reduce mortality. Our analyses recommend the government to set up isolation units in all major hospitals, and proper surveillance system.

BACKGROUND The 2019 novel coronavirus (SARS-COV-2) originated in the central Chinese city, Wuhan by end of December 2019.Pakistan reported its first 2 confirmed cases,on26th February 2020 linked to travel history of Iran. OBJECTIVE The study was conducted to see the trend of covid infection growth and doubling time in Pakistan from an early containment state to much belated exponential rise pattern . METHODS This study is based on analysis of the publicly available data on COVID-19 from Ministry of National Health Services Regulations and Coordination covid-19 dashboard and National Institute Health Islamabad(NIH) situation reports from 26th Feb to 30th March2020. RESULTS A total of 1875 COVID-19 patients has been reported with 25 deaths,11 critically ill and 58 recoveries. Punjab has highest number of confirmed cases (593)Sindh(508),Khyber Pakhtun Khawa (195) Baluchistan(144)Gilgit Baltistan(128),Islamabad Capital territory (51) Azad Jammu Kashmir (6). Majority of effected patients are male(64%).Iran Zairian are making 49% of positive patents Local transmission cases stands at 29%.Daily cases surge is 12.3% increase per day. 30th March 2020 witnessing highest reported cases so far (240 new Cases). Pakistan reached its first 100 confirmed cases on 16th March,2020,20 days after first reported case. The case doubling time was 3 days initially after first cases then it was reported as three days and then five days till 30th March 2020 CONCLUSIONS Grave mishandling, lack of quarantine facility and limited testing capacity at Taftan border crossing resulted in importation of virus in country.Cumulative confirmed case count in Pakistan is still in sub-exponential growth pattern. Stringent risk mitigation measures by provinces and Federal being implemented have resulted in slow rate of infection growth with reduced infection doubling rate in days. Pakistan with limited testing capacity of 2000-3000 tests per day needs Extremely comprehensive testing regime is required to halt the community transmission leading to exponential increase in cases.