Epidemiological trends and risk factors associated with dengue disease in Pakistan (1980–2014): a systematic literature search and analysis

Abstract

BackgroundDengue is becoming more common in Pakistan with its alarming spreading rate. A historical review needs to be carried out to find the root causes of dengue dynamics, the factors responsible for its spread and lastly to formulate future strategies for its control.MethodsWe searched (January, 2015) all the published literature between 1980 and 2014 to determine spread/burden of dengue disease in Pakistan.ResultsA total of 81 reports were identified, showing high numbers of dengue cases in 2010, 2011, and 2013. The tendency of dengue to occur in younger than in older age groups was evident throughout the survey period and all four serotypes were recorded, with DENV1 the least common. Most dengue hemorrhagic fever (DHF) cases fell in the 20–45 years age range. High frequencies tended to be observed first in the Southern coastal region characterized by mild winters and humid warm summers and then the disease progressed towards the lowland areas of the Indus plain with cool winters, hot summers and monsoon rainfall. Based on this survey, new risk maps and infection estimates were identified reflecting public health burden imposed by dengue at the national level.ConclusionsOur study showed that dengue is common in the three provinces of Pakistan, i.e., Khyber Pakhtunkhwa (KP), Punjab and Sindh. Based on the literature review as well as on our study analysis the current expansion of dengue seems multifactorial and may include climate change, virus evolution, and societal factors such as rapid urbanization, population growth and development, socioeconomic factors, as well as global travel and trade. Due to inadequate remedial strategies, effective vector control measures are essential to target the dengue vector mosquito where high levels of human-vector contact occur. The known social, economic, and disease burden of dengue is alarming globally and it is evident that the wider impact of this disease is grossly underestimated. An international multi-sectoral response, outlined in the WHO Global Strategy for Dengue Prevention and Control, 2012–2020, is now essential to reduce the significant influence of this disease in Dengue endemic areas. Overall gaps were identified in knowledge around seroprevalence, dengue incidence, vector control, genotype evolution and age-stratified serotype circulation.

Dengue Outbreaks in Khyber Pakhtunkhwa (KPK), Pakistan in 2017: An Integrated Disease Surveillance and Response System (IDSRS)-Based Report

“…The peak incidence of dengue infection was seen in the post-monsoon season -in October (41%). The similar observation was found in the literature, where a steady increase was measured from August to October Khalid et al 2015;Ghani et al 2017;). This has also been previously shown by others (Khan et al 2006;Khan et al 2013;.…”

“…Moreover, some investigations performed in Singapore showed that the majority of infected patients were older (Gadhwal et al 2016). In this regard, it has been concluded that adults of 16-30 years old in KPK are in the danger region to dengue infection and the risk may depend to the time spend outside (Khan et al 2017). Simultaneously, in the present study, the infection rate was found the highest in the male population (65.33%) in comparison to female (34.66%).…”

“…The dengue infection in Asian countries could be acquired during both outdoor and indoor activities. Based on outdoor and indoor activities, it has been concluded that male in KPK could be more affected with dengue infection in comparison to female (Khan et al 2017;Suleman et al 2017b). The upto-date study is also scrutinized in a month-wise since the incidences of dengue infection were observed from July -December.…”

“…According to recent reports from Pakistan, the major serotypes found in Punjab were DENV 2, 3 and 4; however, DENV 2 and 3 were found in Swat area of KPK province in 2013 with a high morbidity as well as mortality rate (Khan et al 2017;Suleman et al 2017a;Suleman et al 2017b;Khan et al 2018a). The serotype 3 has always predominated (Koo et al 2013). Recently, serotype five (DENV 5) has been revealed via neutralization assays (Ghani et al 2017;Morra et al 2018).…”

“…PCR. To confirm the presence of dengue virus in the samples, the protocol adopted by Khan et al (2017) was followed. Briefly, RNA was extracted and processed with RT-PCR using type-specific DENV primers (TS1-TS4) (Khan et al 2018a).…”