EPIDEMIC DISEASES IN PAKISTAN

1 INTRODUCTION:
An epidemic disease is that disease that spreads rapidly to a large
number of people in a given population within a short period of time.[1]
[2] Epidemics of infectious diseases are generally caused by several
factors including a change in the ecology of the host population. An
epidemic may be restricted to one location; however, if it spreads to
other countries or continents and affects a substantial number of people,
it may be termed a pandemic. The declaration of an epidemic usually
requires a good understanding of a haseline rate of incidence; epidemics
for certain diseases, such as influenza, are defined as reaching some
defined increase in incidence above this baseline[3]. A few cases of a
very rare disease may be classified as an epidemic, while many cases of
a common disease would not.

2 TYPES OF EPIDEMICS:

2.1 Common source outbreak:

In a common source outbreak epidemic, the affected individuals had an
exposure to a common agent. If the exposure is singular and all of the
affected individuals develop the disease over a single exposure and
incubation course, it can be termed a point source outbreak. If the
exposure was continuous or variable, it can be termed a continuous
outbreak or intermittent outbreak, respectively.
2.2 Propagated outbreak:
In a propagated outbreak, the disease spreads person-to-person. Affected
individuals may become independent reservoirs leading to further
exposures.
Many epidemics will have characteristics of both common source and
propagated outbreaks (sometimes referred to as mixed outbreak).
For example, secondary person-to-person spread may occur after a
common source exposure or an environmental vectors may spread
a zoonotic diseases agent.

3 CAUSES:
There are several changes that may occur in an infectious agent that may
trigger an epidemic. These include:
 Increased virulence
 Introduction into a novel setting
 Changes in host susceptibility to the infectious agent
An epidemic disease is not required to be contagious,[4] and the term
has been applied to West Nile fever and the obesity epidemic (e.g., by
the World Health Organisation), among others.
The conditions which govern the outbreak of epidemics include infected
food supplies such as contaminated drinking water and the migration of
populations of certain animals, such as rats or mosquitoes, which can act
as disease vectors.
Certain epidemics occur at certain seasons. For example, whooping-
cough occurs in spring, whereas measles produces two epidemics, one in
winter and one in March. Influenza, the common cold, and other
infections of the upper respiratory tract, such as sore throat, occur
predominantly in the winter. There is another variation, both as regards
the number of people affected and the number who die in successive
epidemics: the severity of successive epidemics rises and falls over
periods of five or ten years.

4 SOME COMMON DISEASES IN PAKISTAN:

4.1 Dengue fever – Pakistan:

Health authorities in Pakistan are responding to an ongoing outbreak of
dengue fever. This outbreak was first reported on 8 July 2019 by the
Khyber Teaching Hospital in Peshawar, Khyber Pakhtunkhwa (KP)
province. Since then, three other provinces (Punjab, Balochistan, and
Sindh), as well as Islamabad Capital Territory (ICT), and Azad Jammu
and Kashmir (AJK; one of the two autonomous territories) have also
reported cases of dengue fever.
From 8 July to 12 November 2019, a total of 47,120 confirmed cases of
dengue fever, including 75 deaths, were reported from the four
provinces (KP, Punjab, Balochistan, and Sindh), Islamabad, and AJK.
The following is a brief update on the dengue fever situation in each of
these areas:
Khyber Pakhtunkhwa (KP):
From 8 July through 12 November 2019, a total of 7,641 confirmed
cases of dengue fever were reported from KP and KP Tribal Districts.
The male to female ratio was 1. Samples were sent for serotyping and
were found positive for dengue virus serotype 1 (DENV-1) and dengue
virus serotype 2 (DENV-2) in KP.
Punjab:
From 1 August through 12 November 2019, a total of 9,676 confirmed
dengue fever cases, including 16 deaths, have been reported. Nine
positive samples from Rawalpindi confirmed the circulation of DENV-2
in the province.
Azad Jammu and Kashmir (AJK):
From 1 August through 12 November 2019, a total of 1,689 confirmed
cases of dengue fever, with one death, were reported.
Islamabad Capital Territory (ICT):
From 6 August through 12 November 2019, 12,986 confirmed cases of
dengue fever, including 22 deaths, have been reported from eight major
hospitals in Islamabad. A total of 17 new samples were tested at the
National Institute of Health (NIH) laboratory in Islamabad. Dengue
virus serotype 1 (DENV-1) and dengue virus serotype 2 (DENV-2)[4]
were isolated from 3 and 14 samples respectively, indicating an ongoing
circulation for both serotypes.
Sindh:
From 1 September through 12 November 2019, a total of 12,053
confirmed cases of dengue fever, including 33 deaths, have been
reported.
Balochistan:
From 18 September through 12 November 2019, a total of 3,075
confirmed cases of dengue fever were reported with three deaths.
Serotyping of five positive samples confirmed the circulation of DENV-
1. Vector surveillance conducted in the province showed the presence
of Aedes aegypti.
4.2 HIV cases–Pakistan:
On 25 April 2019, the local administration in Larkana district was
alerted by media reports of a surge in human immunodeficiency virus
(HIV) cases among children in Ratodero Taluka, Larkana district, Sindh
province, Pakistan. A screening camp was initially established at
Taluka’s main hospital. Later, screening was expanded to other health
facilities including selected Rural Health Centers (RHCs) and Basic
Health Units (BHUs). HIV rapid test kits that were initially used were
replaced with pre-qualified WHO test kits.
From 25 April through 28 June 2019, a total of 30,192 people have been
screened for HIV, of which 876 were found positive. Eighty-two per
cent (719/876) of these were below the age of 15 years. During the
screening, several risk factors were identified, including: unsafe
intravenous injections during medical procedures; unsafe child delivery
practices; unsafe practices at blood banks; poorly implemented infection
control programs; and improper collection, storage, segregation and
disposal of hospital waste.
This is the fourth reported outbreak of HIV in Larkana district since
2003. The first outbreak in 2003, was among people who inject drugs
(PWID), the second was among 12 pediatric patients in a pediatric
hospital in 2016, and the third, also in 2016, was among 206 patients in a
dialysis unit.
Prior to this event, Larkana district had only one antiretroviral therapy
(ART) clinic, which was for adults exclusively (2,568 registered cases
by May 2019).
4.3 Cholera in Pakistan:
25 OCTOBER 2010 - On 12 October 2010, the Ministry of Health in
Pakistan reported laboratory confirmation of 99 cases of Vibrio cholera
01 in the country. These cases were laboratory-confirmed by the
National Institute of Health since the beginning of the flood until 30
September 2010. These cases have been reported sporadically from a
wide geographical area in the flood-affected provinces of Sindh, Punjab
and Khyber Pakhtunkhwa.
The Ministry of Health in Pakistan supported by the World Health
Organization and other local and international partners are collaborating
closely to prevent outbreaks of any disease, including cholera, and treat
people affected by such illnesses. More than 60 diarrhoeal treatment
centres are either operating or are soon to start functioning in the 46
most affected districts of the country.
Diarrhoeal diseases including cholera are among the most reported
health conditions in many locations affected by the recent floods disaster
in the country.

5 REFERENCES:

1. ^ Jump up to:a b c d e f g Principles of Epidemiology, Third

Edition (PDF). Atlanta, Georgia: Centers for Disease
Control and Prevention. 2012.
2. ^ Jump up to:a b c d e f Green, M. S.; Swartz, T.; Mayshar, E.; Lev,
B.; Leventhal, A.; Slater, P. E.; Shemer, J. (January
2002). "When is an epidemic an epidemic?" (PDF). The
Israel Medical Association Journal. 4 (1): 3–
6. PMID 11802306.
3. ^ "epidemic". The Encyclopedia of Ecology and
Environmental Management, Blackwell Science. Oxford:
Blackwell Publishers, 1998. Credo Reference. Web. 17
September 2012.
4. ^ Jump up to:a b c d e Martin, Paul M.V.; Martin-Granel, Estelle
(June 2006). "2,500-year evolution of the term
epidemic". Emerging Infectious Diseases. 12 (6): 976–
80. doi:10.3201/eid1206.051263. PMC 3373038. PMID 16
707055.
5. ^ Lodge, T. (1603). A treatise of the plague: containing the
nature, signes, and accidents of the same, with the certaine
and absolute cure of the fevers, botches and carbuncles that
raigne in these times. London: Edward White.