Introduction: COVID-19, a novel disease, appeared in December 2019 in China and rapidly spread across the world. Till the second week of April 2020, high incidence (2.9/100,000) and cases fatality rates (1.7%) were observed in Pakistan. This study was conducted to determine the temporal and spatial distribution of the first 100 deaths attributed to COVID-19 in Pakistan and their associated demographic factors. Method: A record review of the first 100 deaths reported among RT-PCR confirmed COVID-19 cases was conducted. Demographic, epidemiological, and risk factors information was obtained associated comorbidities and clinical signs and symptoms were recorded and frequencies were determined. Results: A total of 100 mortalities with an overall case fatality rate of 1.67% (CFR) were analyzed. The median age of patients was 64.5 years (IQR: 54-70) with 75% (n=75) males. Among all deaths reported, 71 (71%) cases had one or more documented comorbidities at the time of diagnosis.  The most frequently reported co-morbidities were: hypertension (67%), followed by Diabetes Mellitus (45%) and Ischemic Heart Diseases (27%). The most frequent presenting symptoms were shortness of breath (87%) and fever (79%). The median duration of illness was eight days (IQR: 4-11 days), the median delay reaching hospital to seek health care was three days (IQR: 0-6 days) while the median duration of hospital stay was also three days (IQR: 1-7 days). Among all, 62% had no history of international travel. The most affected age group was 60-69 years while no death reported in the age group below 20 years.

Introduction: Serological surveys are valuable tools to evaluate the extent of disease transmission, measuring preventive effectiveness and proportion of asymptomatic individuals. This age-stratified, serological survey was aimed to measure the COVID-19 distribution and determinants in district Islamabad of Pakistan. Methodology: Three-stage cluster sampling, using population proportionate to size technique, starting with a random number was used. A structured, pretested questionnaire was used after taking informed written consent, to gather demographic, risk factor information. Results: Seroprevalence was found 16.5% (AR: 16.5%/100,000). The mean age was 35 (sd:16 Years). The majority were male (64%), self-employed (29%), and had primary level education (33%). The highest seroprevalence was found in the 21-30 years age group (24.8%) while the 41-50 years age group showed the highest attack rate (112.9/100,000 population). The proportion of the population tested that were asymptomatic was 69% (n=711) while the most frequently reported sign/symptom was cough (99%) followed by fever (20%). No known co-morbidity was reported in 86% (n=884) of respondents while hypertension remained the most reported condition (8%). High seroprevalence was observed in urban areas (12.3%) compared to rural union councils (6.4%). Visiting a house where COVID-19 case was isolated (OR 2, CI 1.38-2.84, P< 0.001), history of contact with a known case of COVID-19 (OR 1.42, CI 1.11-1.82, P=0.005), and attending a mass gathering (OR 1.21, CI: 1.02-1.42, p=0.02) were significant risk factors associated with contracting an infection. A Chi-Square test of independence showed significant protection while using regular hand hygiene practices (6.5; p<0.05) and regular usage of face masks (8.6; p<0.05). Conclusion: Seroprevalence gives a direct estimation of population groups exposed to the virus. A remarkable difference in prevalence is found in urban and rural areas, extreme age groups, and socioeconomic statuses, suggesting targeted public health interventions. Sero-studies are affordable counterparts of molecular testing where quick estimation, prevention effectiveness, and data-driven public health policies are priorities.

Introduction: COVID-19, a novel disease, appeared in December 2019 in China and rapidly spread across the world. Till the second week of April 2020, high incidence (2.9/100,000) and cases fatality rates (1.7%) were observed in Pakistan. This study was conducted to determine the temporal and spatial distribution of the first 100 deaths attributed to COVID-19 in Pakistan and their associated demographic factors. Method: We conducted a descriptive epidemiological analysis of the first 100 deaths reported among RT-PCR confirmed COVID-19 cases. Demographic, epidemiological, and risk factors information was obtained associated comorbidities and clinical signs and symptoms were recorded and frequencies were determined. Results: A total of 100 mortalities with overall Case Fatality Rate 1.67% (CFR) were analysed. Median age of patients was 64.5 years (IQR: 54-70) with 75% (n=75) Males. Among all deaths reported, 71 (71%) cases had one or more documented comorbidities at the time of diagnosis. Most frequently reported co-morbidities were; hypertension (67 %), followed by Diabetes Mellitus 945%) and Ischemic Heart Diseases (27%). First death was reported on 18 March 2020 and the most frequent presenting symptoms were shortness of breath (87%) and fever (79%). Median duration of illness was eight days (IQR: 4-11 days), the median delay reaching hospital to seek health care was three days (IQR: 0-6 days) while median duration of hospital stay was also three days (IQR: 1-7 days). Among all reported deaths, 62% were attributed to local transmission as these cases had no history of international travel. The most affected age group was 60-69 years while no death reported in age group below 20 years. Conclusion: High CFR among old age group and its association with co-morbidities (chronic disease) suggests targeted interventions such as social distancing and strict quarantine measure for elderly and morbid people. Comparative studies among deaths and recovered patients are recommended to explore further disease dynamics. Key words: COVID-19, Cases Fatality Rates, Co-morbidities, Epidemiology, Pakistan, Co-morbidities

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Background: In the second week of October 2019, five suspected cases of dengue fever were reported from union council Sohan, Islamabad rural (population 45,747) to the health department, Islamabad Capital Territory (ICT).  Outbreak investigation was conducted with the objectives to identify risk factors and to recommend control measures. Methods: Outbreak investigation was conducted from 17 th October to 25 th November 2019. A case was defined as, “fever and two or more of the following signs/symptoms; headache, retro-orbital pain, joint/bone pain, myalgia and petechial rash with NS1 test (Nonstructural Protein 1) positive during 8 th October to 25 th November 2019 among residents of Sohan”. Age and sex-matched controls were recruited from the same neighborhood. All cases were positive for NS1 antigen. Blood samples from five suspected cases were collected and tested for laboratory confirmation. Results:   A total of 547 households were surveyed and 85 cases were identified. The mean age was 34.4 years + 16.05 (range 3-71 years). The attack rate was 0.19% whereas the most affected age group was the 45-54 years (AR 0.43%). Males were predominantly affected (n=48 56.5%). Among all cases, 32% (n=27)) had stagnant water inside or around their houses (aOR 2.65, CI 1.20-5.83, P= 0.005), 33% (n=28) were using mosquito repellent (aOR 0.35, CI 0.17-0.70, P <0.001), 31% (n=26) used indoor residual spray insecticide (aOR 0.48, CI 0.24-0.97, P =0.041), and 73% (n=62) used full protective clothing (aOR 0.17, CI 0.05-0.58, P <0.001). All five blood samples were tested positive for NS-1 antigen. Conclusion: The presence of accumulated rainwater in pools and empty receptacles around houses acted as breeding grounds for Aedes aegypti mosquitos and was the most probable cause of this outbreak. Following our recommendations, the health department-initiated mosquito breeding sites control activities through residual insecticide spray and advocacy on the use of protective measures against mosquito bites.