Chikungunya in Pakistan: Where is it now?

A study in March 2015 conducted by King Edward Medical University, Lahore confirmed CHIKV prevalence amongst patients suspected to have acquired Dengue Fever in Lahore, Punjab. Not many cases were found in that study but those found warned the authorities to keep a high index of suspicion for Chikungunya in Pakistan. A study in 1983 also confirms high over-all prevalence rates of certain mosquito-borne diseases that included Chikungunya, Zika, Dengue etc.

Despite no reports of Chikungunya cases before in Pakistan, it was too early to claim its origin from India as claimed earlier in an article published by Tribune.  Even though a number of cases has been reported in Delhi the previous year, there is no doubt that both countries share same climatic, geographical conditions and have fragile health infrastructure that cannot effectively diagnose and treat patients infected with such arboviruses. There are chances that mosquito borne diseases can be imported from travelers journeying from endemic countries as in case of Zika. But diseases like Chikungunya and Zika can co-exist in a Dengue infected population for a very long time.

Chikungunya outbreak in Pakistan started in November, 2016, infected an estimated number of 30,000 locals of Karachi. Earlier during the start, the authorities refused any claims that this is another mosquito-borne virus. The Ministry of Health alongside WHO shrugged off any reports of CHIKV transmission circulating in Pakistan’s population. Despite its confirmed possibility of existence amongst population both the authorities rubbished the reports of suspected Chikungunya cases as an unnecessary hype created by media channels.

Although blood samples were dispatched to National Institute of Health (NIH) for serological confirmation, it was not until the end of 2016 that Pakistan’s Ministry of National Health Services, Regulation and Coordination (NHSRC) for the first time officially reported the outbreak Chikungunya to World Health Organisation (WHO). Director General Health, Dr. Asad Hafeez as assured that the said situation is very much under control and only 5 cases have been confirmed so far by NIH. Samples sent to other laboratories of Dow University of Health Sciences and Agha Khan University Hospital’s department of Pathology and Laboratory Medicine, have not been added in the reports yet.

Furthermore, 803 cases have been reported since the outbreak was first confirmed in December, 2016, including 29 additional cases that surfaced between 10-16 February, 2017. 71 samples from a total of 92 are confirmed through qualitative RT-PCR.

A correspondence from this year’s issue of The Lancet is of the opinion that the outbreak is due to climate change and Karachi’s poor water and sanitary conditions. There is no doubt that Karachi adds more than 0.6 million people to its tally annually, but the bulk water supply does not scale up correspondingly. For the past many years, the supply has been static at 550m gallons per day (mgd) against a standing demand of 1.1 billion mgd. This inaccessibility of water forces people to store it in containers that later become mosquito breeding places, therefore, water scarcity discourages dwellers to drain the water that has become a mosquito larva source.

Pakistan has been dealing with ‘Aedes aegypti’ for well over 10 years. So, a same vector control strategies can be approached to avoid spread of Chikungunya as well as Zika, if the disease is clinically reported in the country. Alongside this, a socially mobilized vector control abatement program has to be initiated which performs synchronically with other defined ways to manage prevalent arboviruses in Pakistan.

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