Viral outbreaks and communicable health hazards due to devastating floods in Pakistan

Wolbachia: A bacterial weapon against dengue fever- a narrative review of risk factors for dengue fever outbreaks

Arboviruses constitute the largest known group of viruses and are responsible for various infections that impose significant socioeconomic burdens worldwide, particularly due to their link with insect-borne diseases. The increasing incidence of dengue fever in non-endemic regions underscores the urgent need for innovative strategies to combat this public health threat. Wolbachia, a bacterium, presents a promising biological control method against mosquito vectors, offering a novel approach to managing dengue fever. We systematically investigated biomedical databases (PubMed, Web of Science, Google Scholar, Science Direct, and Embase) using "AND" as a Boolean operator with keywords such as "dengue fever," "dengue virus," "risk factors," "Wolbachia," and "outbreak." We prioritized articles that offered significant insights into the risk factors contributing to the outbreak of dengue fever and provided an overview of Wolbachia's characteristics and functions in disease management, considering studies published until December 25, 2024. Field experiments have shown that introducing Wolbachia-infected mosquitoes can effectively reduce mosquito populations and lower dengue transmission rates, signifying its potential as a practical approach for controlling this disease.

Emerging Arboviral Diseases in Pakistan: Epidemiology and Public Health Implications

Arboviruses pose significant public health challenges globally, particularly in Pakistan, where deforestation, climate change, urbanization, inadequate sanitation, and natural disasters have all contributed to the spread of mosquito-borne flavivirus diseases like dengue fever. The lack of a thorough national surveillance system has made it difficult to determine the extent and distribution of these diseases. Concern has been raised by recent outbreaks of West Nile virus (WNV) and chikungunya (CHIKV) epidemics, which may lead to Zika virus (ZIKV) outbreaks in the future. Additionally, hospital-based surveillance has detected the Japanese encephalitis virus (JEV) in the region. Evidence also points to the presence of additional arboviruses in healthy populations, such as the Karshi virus (KSV), Tamdy virus (TAMV), Crimean-Congo hemorrhagic fever virus (CCHFV), and severe fever with thrombocytopenia syndrome virus (SFTSV). This review aims to address the risk factors linked to these diseases, provide specific policy recommendations for efficient disease prevention and control, and describe the epidemiological trends of these diseases in Pakistan while emphasizing the critical need for improved surveillance and thorough epidemiological investigations.

Impact of prolonged flooding in Pakistan: In the middle of unexpected health emergency

Floods are the most frequent disaster risk factor, and they have significantly increased morbidity and mortality globally. However, the health effects of a specific flood depend on the surrounding circumstances and the current situation in Pakistan indicates that it is leading to a serious health crisis. The immediate health effects of flooding include waterborne and vector-transmitted diseases. The evacuation of patients, loss of medical personnel, and destruction of critical medical supplies and equipment are also overburdening the Pakistani healthcare system. The indirect effects of flooding include infected wounds, poisoning, poor mental health, infectious infections, and famine. Long-term consequences could include starvation, chronic illness, disability, poor mental health, and diseases linked to poverty. In this letter to the editor, we discussed the challenges, efforts, and recommendations that can facilitate the system.

Screening for Arboviruses in Healthy Blood Donors: Experience from Karachi, Pakistan (Jul-Dec 2018)

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DENV, WNV and JEV status was investigated in healthy blood donors at the Aga Khan University July to December 2018.

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ELISA for IgM antibodies and RT-PCR for viral RNA detection were performed.

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IgM antibodies for DENV and WNV were positive in 3.9% and JEV in 0.28% of the blood donors.

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Blood donors aged 19 and 30 years and residents of urban areas, of Karachi City were most frequent.

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DENV and WNV seropositivity were significantly associated with residence in Malir District of Karachi.

Epidemiological trends of mosquito-borne viral diseases in Pakistan

Globally, arboviruses are public health problems. Pakistan has seen a fast-paced increase in mosquito-borne Flavivirus diseases such as dengue because of deforestation, climate change, urbanization, poor sanitation and natural disasters. The magnitude and distribution of these diseases are poorly understood due to the lack of a competitive nationwide surveillance system. In dengue-endemic countries, the recent epidemics of chikungunya (CHIKV) and human West Nile virus (WNV) have created panic among the public and are thought to provoke an outbreak of Zika virus (ZIKV) in Pakistan. Recently, hospital-based surveillance has indicated the presence of Japanese encephalitis virus (JEV), which is deeply concerned by developing countries such as Pakistan. The situation could become more devastating because of poorly developed diagnostic infrastructure. To date, no licensed vaccine has been used in Pakistan, and preventive measures are mainly based on vector control. This review provides comprehensive information concerning the association of risk factors with disease occurrence, epidemiological trends, and prediction of the spread of mosquito-borne diseases, attention to new threats of ZIKV, and future perspectives by benchmarking global health policies.

Evaluation of SARS-CoV-2 antigen-based rapid diagnostic kits in Pakistan: formulation of COVID-19 national testing strategy

Rapid diagnosis of SARS-CoV-2 during pandemic enables timely treatment and prevention of COVID-19. Evaluating the accuracy and reliability of rapid diagnostic testing kits is crucial for surveillance and diagnosis of SARS-CoV-2 infections in general population, injection drug users, multi-transfused populations, healthcare workers, prisoners, barbers and other high risk populations. The aim of this study was to evaluate performance and effectiveness of nasopharyngeal swab (NSP) and saliva based rapid antigen detection testing kits in comparison with USFDA approved triple target gold standard real-time polymerase chain reaction. A cross-sectional study was conducted on 33,000 COVID-19 suspected patients. From RT-PCR positive patients, nasopharyngeal swab (NSP) and saliva samples were obtained for evaluation of rapid COVID-19 testing kits (RDT). 100/33,000 (0.3%) of specimens were RT-PCR positive for SARS-CoV-2. Among RT-PCR positive, 62% were males, 34% were females, and 4% were children. The NSP-RDT (Lepu Medical China) analysis revealed 53% reactivity among males, 58% reactivity among females, and 25% reactivity among children. However saliva based RDT (Lepu Medical China) analysis showed 21% reactivity among males and 23% among females, and no reactivity in children. False negative results were significantly more pronounced in saliva based RDT as compared to NSP-RDT. The sensitivity of these NSP-RDT and saliva based RDT were 52% and 21% respectively. The RDTs evaluated in this study showed limited sensitivities in comparison to gold standard RT-PCR, indicating that there is a dire need in Pakistan for development of suitable testing to improve accurate COVID-19 diagnosis in line with national demands.

A time-trend ecological study for identifying flood-sensitive infectious diseases in Guangxi, China from 2005 to 2012

BACKGROUND

Flood-related damage can be very severe and include health effects. Among those health impacts, infectious diseases still represent a significant public health problem in China. However, there have been few studies on the identification of the spectrum of infectious diseases associated with floods in one area. This study aimed to quantitatively identify sensitive infectious diseases associated with floods in Guangxi, China.

METHODS

A time-trend ecological design was conducted. A descriptive analysis was first performed to exclude infectious diseases with low incidence from 2005 to 2012 in ten study sites of Guangxi. The Wilcoxon rank-sum test was applied to examine the difference in the ten-day attack rate of infectious diseases between the exposure and control periods with different lagged effects. Negative binomial, zero-inflated Poisson and zero-inflated negative binomial models were used to examine the relationship and odd ratios (ORs) of the risk of floods on infectious diseases of preliminary screening.

RESULTS

A total of 417,271 infectious diseases were notified. There were 11 infectious diseases associated with floods in the preliminary screening process for flood-sensitive infectious diseases. The strongest effect was shown with a 0-9 ten-day lag in different infectious diseases. Multivariate analysis showed that floods were significantly associated with an increased the risk of bacillary dysentery (odds ratio (OR) = 1.268, 95% confidence interval (CI): 1.072-1.500), acute haemorrhagic conjunctivitis (AHC, OR = 3.230, 95% CI: 1.976-5.280), influenza A (H₁N₁) (OR = 1.808, 95% CI: 1.721-1.901), tuberculosis (OR = 1.200, 95% CI: 1.036-1.391), influenza (OR = 2.614, 95% CI: 1.476-4.629), Japanese encephalitis (OR = 2.334, 95% CI: 1.119-4.865), and leptospirosis (OR = 1.138, 95% CI: 1.075-1.205), respectively.

CONCLUSION

The spectrum of infectious diseases which are associated with floods are bacillary dysentery, AHC, influenza A (H₁N₁), tuberculosis, influenza, Japanese encephalitis and leptospirosis in Guangxi. Floods can result in differently increased risk of these diseases, and public health action should be taken to control a potential risk of these diseases after floods.

Epidemiology and risk factors of transfusion transmitted infections in thalassemia major: a multicenter study in Pakistan

Background

Blood transfusion-transmitted infections in individuals suffering from beta-thalassemia have been reported in Pakistan, but the information on their sociodemographic and clinical determinants is lacking. This study aims to describe the prevalence, as well as the factors, contributing in blood transfusion-transmitted infections.

Method

Between December 2011 and December 2013, in a non-probable sampling, 350 thalassemia patients were recruited in Lahore, Multan, Karachi and Peshawar, Pakistan. Subjects were screened for transfusion-transmitted infections.

Results

A seropositive rate of 36.5% was observed; males (94, 73.4%) and females (34, 26.6%). Among several risk factors associated with transfusion-transmitted infections, province (p = 0.001), gender (p = 0.003), age (p < 0.03), education (p < 0.00), degree of consanguinity (p = 0.05), age at fetal blood test (p = 0.005), fetal hemoglobin levels (p = 0.005), death due to thalassemia (p = 0.001) and iron-related complications (p = 0.04) showed significant correlation. Participants with an age >10 years were significantly more prone to seropositivity than those aged ≤10 years. Moreover, the ferritin level was also significantly higher in those aged >10 years than in those ≤10 years. It was observed that males had a higher seroprevalence rate (94, 73.4%) than females (34, 26.6%). The most prevalent transfusion-transmitted infections was the hepatitis C virus, with 115 cases (89.8%).

Conclusion

A high prevalence rate of HCV in subjects with transfusion-dependent thalassemia is linked with insufficient facilities, poor management and compromised socioeconomic status. Therefore, more multicenter studies covering cities from different regions of the country are needed in order to develop preventive measurements at the regional and national level.

Possible viral infections in flood disasters: a review considering 2019 spring floods in Iran

Floods are one of the natural disasters occurring worldwide which have a massive range of health impacts. In addition to immediate dangers such as drowning, floods can increase the transmission of some communicable diseases. Up to now there was no report of viral infection outbreaks after 2019 spring floods in Iran. This review explains the possible viral infections which may occur during or after floods.

Prioritizing the needs of children in a changing climate

In a Perspective, Lawrence Stanberry and colleagues discuss impacts of climate change on children.

Impact of climate change on dermatological conditions related to flooding: update from the International Society of Dermatology Climate Change Committee

Climate change contributes to the increase in severity and frequency of flooding, which is the most frequent and deadly disaster worldwide. Flood-related damage can be very severe and include health effects. Among those health impacts, dermatological diseases are one of the most frequently encountered. Both infectious and noninfectious dermatological conditions are increasing after flooding. We searched PubMed using the search term climate change OR global warming OR rainfall OR flooding OR skin. Articles published in the English-language literature were included. We also searched the International Society of Dermatology website library on climate change for additional articles. There is an increased risk of trauma during the course of a natural disaster. The majority of post-tsunami wound infections were polymicrobial, but gram-negative bacteria were the leading causes. Infectious diseases with dermatological manifestations, such as impetigo, leptospirosis, measles, dengue fever, tinea corporis, malaria, and leishmaniasis, are important causes of morbidity among flood-afflicted individuals. Insect bites and stings, and parasite infestations such as scabies and cutaneous larva migrans are also frequently observed. Inflammatory conditions including irritant contact dermatitis are among the leading dermatological conditions. Dermatological conditions such as alopecia areata, vitiligo, psoriasis, and urticaria can be induced or exacerbated by psychological conditions post disaster. Prevention is essential in the management of skin diseases because of flooding. Avoiding exposure to contaminated environments, wearing protective devices, rapid provision of clean water and sanitation facilities, prompt vector controls, and education about disease risk and prevention are important.