The changing epidemiological pattern of Dengue in Swat, Khyber Pakhtunkhwa

Abstract

BackgroundPakistan is suffering from dengue fever since 1994. In the country, major dengue outbreaks have been documented in 2010, 2011 and 2013 in Punjab (Lahore) and Sindh (Karachi) Provinces. District Swat was hit for the first time by dengue virus in 2013, claiming 57 deaths and 8000 morbidities. The molecular and entomological aspects along with the ecological and social context of the dengue outbreaks were investigated in this study.MethodIn addition to entomological survey, the data collected from patients' files (Saidu Sharif Teaching Hospital, Swat) and by directly questioning the patients (field data) was analyzed for epidemiological trends, molecular identification (RT-PCR based serotyping of DENV), clinical profile, socioeconomic status (SES) and demographic features.ResultsThe peak prevalence of dengue was documented in September (56% in 2013, 38% in 2014) and October (33% in 2013, 24% in 2014), whereas in 2015, in October (54.5%) and November (30.5%). The serotype 3 (≤60%) and serotype 2 (≤40%) were found dominant in the area. Among the reported patients (5513), 69% were males and 31% females. Majority of them were found in the age of 14–30 years (52.5%) as compared to 31–60 years (34.5%) (Chi-square: 3219.463, p-value: 0.00). About 63% cases reported in low SES. Among the different categories of government employees affected with dengue, majority (4%) were belonging to health department (Chi-square: 4541.011, p-value: 0.00). Similarly, dengue targeted the dwellers living in multiple-storey houses (65%) as compared to those in the single-storeyed houses (35%) (Chi-square: 495.630, p-value: 0.00). The overall death toll observed was of 57 persons. Dengue prevailed more (38.4%) among low qualified individuals as compared to high qualified (11.5%) (Chi-square: 884.315, p-value: 0.00).ConclusionOur analysis indicated a decrease in the epidemiological trend of dengue (now) in the area, though initially it was observed affecting all types of communities on a larger scale. However, the DENV-2 and DENV-3 were dominantly circulating in the area and the prevalence (with usual peaks in post-monsoon) found high in males, illiterate (less educated) individuals and in those with low SES. Urbanization, infected human travelling, climate change, socioeconomic, sociodemographic as well as the wide range adaptation of vector mosquitoes, altogether, are the important factors playing role in the expansion of dengue. Further studies are needed to determine the association of these variables with the dengue spread in the area.

Pakistan: A nation held back by NTDs

“…albopictus is also present, and in some areas, both vector species are found and are capable of transmitting dengue and potentially other arboviruses [ 28 ]. According to the GBD 2016, the incidence of dengue has increased more than 1,000% since the 1990s when the first major outbreak occurred in Karachi [ 29 ], such that it is now the second most common NTD behind ascariasis. The largest dengue outbreaks occurred in Lahore in 2011, which resulted in more than 300 deaths, and then in Swat in 2013 with more than 50 deaths [ 29 ].…”

“…According to the GBD 2016, the incidence of dengue has increased more than 1,000% since the 1990s when the first major outbreak occurred in Karachi [ 29 ], such that it is now the second most common NTD behind ascariasis. The largest dengue outbreaks occurred in Lahore in 2011, which resulted in more than 300 deaths, and then in Swat in 2013 with more than 50 deaths [ 29 ]. Dengue outbreaks and epidemics are most common following monsoon season, with dengue virus (DENV) 2 and DENV 3 often predominating in urban areas [ 29 ].…”

Knowledge of dengue disease amongst paramedical students of independent school of paramedics Faisalabad.

“…11 Human travelers play an important part not only in the global spread of dengue disease but also between the different regions of the same country as they carry dengue virus in their blood to dengue non-endemic areas. 12,13 Main symptoms of dengue are fever, severe headache, eye pain, myalgia, arthralgia, rash, bleeding from nose, gums or teeth. Warning signs of dengue disease are severe abdominal pain, vomiting, drowsiness, cold clammy skin, difficulty in breathing and restlessness.…”

“…8 Important preventive measures include elimination of Aedes mosquito breeding places like stagnant water in and around houses, environmental sanitation including disposing of solid waste, using mosquito skin repellents, wearing body covering clothes, using window and door screens, using insecticide spray and improving community participation. 3,8,9,13,15,16 Knowledge of dengue disease transmission, symptoms, prevention and management is important for healthcare and paramedical staff in order to control and prevent the disease. 17,18 With this background, this study was undertaken to assess knowledge of dengue fever among paramedical students of Independent School of Paramedics as their adequate knowledge of dengue disease is important for the control and prevention of disease.…”

Correction: The changing epidemiological pattern of Dengue in Swat, Khyber Pakhtunkhwa

“…Khan J, Ghaffar A, Khan SA (2018) Correction: The changing epidemiological pattern of Dengue in Swat, Khyber Pakhtunkhwa. PLoS ONE 13(9): e0204465.…”