Dengue in Pakistan
Dengue is the most important vector-borne tropical viral disease around the glob. It is
estimated that each year 50 million cases of dengue fever and 500,000 cases of dengue
hemorrhagic fever occur with at least 30,000 deaths mainly amongst children, although the
fatalities could be twice as high. Before 1970, only 9 countries had experienced the disease.
However, the number has increased to more than 100 countries in 2004/05. DHF is a more
severe form of dengue infection. It can be fatal if unrecognized and not properly treated in a
timely manner. With good medical management, mortality due to DHF can be less than 1%.
The DHF is an acute medical emergency and presents with high grade fever, pains/aches
and signs/ symptoms of generalized bleeding. The DHF is however not a contagious
disease. The patients are basically managed symptomatically. Correct and timely initiation of
management surely saves life.
In PAKISTAN dengue is emerging as one of the major public-health problem particularly
since 2005 threatening the millions of people due to prevailing peculiar socio-economic
conditions and epidemiological situation. Historically dengue has been endemic in the
southern parts of country. In Pakistan first time dengue was recognized in 1994 in Karachi
and 1 patient out of 145 was died. In October 1995, 57 out of 76 persons were found
positive for antibodies against dengue virus in Hub, Southern Balochistan. In October 2003
dengue outbreaks were detected for the first time in sub-mountainous areas of district
Haripur, Khyber Pakhtoonkhawa province and district Khushab, Punjab Province claiming 6
lives among 717 cases. In October 2005, Dengue again hit Karachi after 10 years and 21
deaths out of total 103 confirmed cases were recorded. Since then, the disease has become
widely accepted as one of the major public health problems in Pakistan reporting 26,270
cases and 156 deaths till 2010. During 2011 (Till 17 September), There are 6866 cases and
44 deaths in country.
Now a days there is huge outbreak of dengue in Lahore, Punjab and other provinces and
Provincial Health Government of Punjab taking all possible steps on “War-Footing” to
contain this outbreak. However, there are some recommendations from Govt of Punjab for
the control of dengue outbreak in Lahore which are technically NOT SOUND
RECOMMENDATIONS as explained blow;
1. BAN ON SWIMMING POOLS:
Swimming Pools HAVE NO ROLE in breeding of Aedes mosquitoes because of;
There are always heavy tides on surface of water in swimming pools
due to wind, human activities etc. Mosquito larvae keep their
breathing tube outside the surface of water and if there is any VERY
SLIGHT movement on water surface they will dive down and will later
on come on surface. Larvae are also so sensitive that even if there is
shadow of human on water surface, mosquito larvae will also dive
down and later they will come to surface for breathing. If there are
regular disturbance on water surface larvae CAN NEVER SURVIVE
IN SUCH DISTUBED WATER HABITATS. Even adult female never
prefer to lay eggs in such disturbing water!!!!!!!!!!!! So if there are heavy tides on water surface of
swimming pools due to regular use by human, air winds it is NOT POSSIBLE FOR
MOSQUITOES FOR BREEDING IN SWIMMING POOLS.
Muhammad Mukhtar. Senior Vector Control Specialist. Cabinet Secretariat. Govt. of Pakistan. Mukasbilumm@gmail.com
Dengue in Pakistan
Secondly these pools are made of concrete tiles and there is no emergent vegetation along the
margin of pond and more important any sedimentation at bottom (food of larvae). The presence
of vegetation in open habitats is also another PRIMARY REQUIREMENT for breeding of
mosquitoes.
Thirdly the walls of swimming pools are PERPENDICULAR RATHER SLANTING, WHICH
FUTHER PREVENT THE BREEDING OF MOSQUITOES in such structures of habitats.
References:
1.
2.
Jeroen and Mukhtar. Simple intervention to reduce the breeding of mosquitoes in waste stabilization ponds.
Trans. of Royal Soc. of Trop Med & Hyg. 101: 1143-1146. 2007
Mukhtar et al 2006. Breeding of medically important mosquitoes in waste stabilization ponds. J. Med. Ent. 43
(5):996-1003)
2. BAN ON MORNING ASSEMBLY.
Mosquitoes always/mostly BITE when human are in SATIONARY condition or there is least
or NO MOVEMENT (sleeping times) so there is no risk of bite during morning assembly.
Secondly there is minimum risk of bite of dengue mosquitoes in open areas and morning
assembly are always take place in open areas like play ground of school collage!!!!!!
3. CLOSING OF SCHOOLS FOR 10 DAYS
This is MOST SURPRISING step taken by Govt of Punjab, because if the school collages
close for 10 days, student will sleep at home for longer time (till 10:00 am) which makes
them MORE VULNERABLE FOR BITE OF DENGUE MOSQUITOES. Because when
students will be in school there will be movements of human body all the time which reduces
the chances of bites of mosquitoes instead of sleeping INSIDE OF HOMES. Secondly the
school collages and universities have been closed for 10 days (till 25th Sep) while dengue
scenario will be continued TILL 3RD WEEK OF OCTOBER!!!!!!!!!!!! How these 10 days
closure of educational institute will reduce the incidence of dengue rather IT WILL NOT
ONLY INCREASE THE DISEASE CASELOAD but also cause huge loose of very valuable
time of students. !!!!!!!!!!!!
4. CLOSURE OF SERVICE STATIONS FOR UNKNOWN TIME
Service stations are always present at busiest place of city/town and there is also a huge
mixture of detergents in water coming out from service station. Aedes aegypti and A.
albopictus are important vectors of dengue and dengue hemorrhagic fever in Southeast Asia
including Pakistan and traditionally both species have been closely associated with human
dwellings due to its breeding preference for clean water DOMESTIC habitats. Both species
particularly A. aegypti are believed to be associated with MAN-MADE ARTIFICIAL
HABITATS IN SHADED PLACES in human dwellings. Due to high contamination of water
with detergents coming out from service station, there is NO BREEDING DENGUE
MOSQUITOES in water coming out service stations.
Muhammad Mukhtar. Senior Vector Control Specialist. Cabinet Secretariat. Govt. of Pakistan. Mukasbilumm@gmail.com
Dengue in Pakistan
Reference:
1. Nathaly Herell and Mukhtar. Breeding of mosquitoes in irrigated areas of South PunjabPakistan. Med & Vet Entomology. 15: 236-248. 2001.
2. Mukhtar et al., Entomological Investigations of dengue vectors in Epidemic prone districts of
Pakistan during 2006-2010. Forthcoming 2011)
5. RELEASE OF FISHES IN OPEN PONDS
Today there is another astonish step taken by Punjab Govt i.e. release of fishes to control
dengue mosquitoes. Again here there are some technical concerns;
In Southeast Asia including Pakistan, there are two important vectors of dengue and
dengue hemorrhagic fever named A. aegypti and A. albopictus and both species
particularly A. aegypti are believed to be associated with MAN-MADE artificial habitats
which are placed at shaded places in human dwellings due to its breeding preference for
clean water domestic habitats.
 During our 16 comprehensive dengue filed investigations conducted jointly by Ministry of
Health, NIH, WHO across the country (Karachi, Hyderabad, Lahore, Faisalabad,
Chakwal, Attock, Haripur, Rawalpindi and Islamabad) during 2005-2010, we could not
find any larvae of Aedes aegypti in these ponds. 100% positive samples of water were
from inside the houses and within household most attracted breeding sites were
“Underground Water tanks, Earthen Pitchers, drums, money plant bottles etc. So there is
no record of breeding of Aedes aegypti in open ponds particularly when they are huge in
size!!
 These ponds as we shown on TV have organically polluted water as there were some
animal dung and other organic pollutants were present. The physio-chemical
characteristics (BOD, DO, EC, pH, TDS) of water in these ponds are major
DETERRENTS for breeding of Aedes aegypti in such water habitats. At present there
are two well known species of fishes which are being used for mosquito control around
the globe i.e. Gambusia affinis and Poecilia reticulate. Later is normally used in
CLEAN WATER HABITATS, but small level like in fountains big money plants vassals
etc. However their use in huge ponds has questions of level of success. The former
species is used in organically polluted water, but its rate of success is again very low in
big ponds. In Thailand and Malaysia etc by law each fountain, plan vessels having water
must have Gambusia fish to control dengue.
 Very important to note that in Pakistan in organically polluted water habitats, ONLY
Culex mosquitoes have been reported and well documented in literature around the
glob. Luckily the diseases transmitted by these Culex mosquitoes are not present in
Pakistan. From Pakistan we have collected 3.7 million larvae of Culex mosquitoes from
organically polluted habitats during last 13 years of research work. So we have huge
research record on breeding preferences of mosquitoes in different water habitats with
respect to Physio-Chemical parameters of these water bodies in Pakistan.
Muhammad Mukhtar. Senior Vector Control Specialist. Cabinet Secretariat. Govt. of Pakistan. Mukasbilumm@gmail.com
Dengue in Pakistan
1.
2.
3.
4.
Nathaly Herell and Mukhtar. Breeding of mosquitoes in irrigated areas of South Punjab-Pakistan. Med &
Vet Entomology. 15: 236-248. 2001.
Mukhtar et al., Entomological Investigations of dengue vectors in Epidemic prone districts of Pakistan
during 2006-2010. Forthcoming 2011)
Mukhtar et al 2006. Breeding of medically important mosquitoes in waste stabilization ponds. J. Med.
Ent. 43 (5):996-1003)
Nathlay, Mukhtar and et al., 2001. Adult anophelines ecology and malaria transmission in PunjabPakistan. Medical and Veterinary Entomology (2004) 18, 141–152
Overall this shows that these recommendations made by Govt. of Punjab are not EVIDENCEBASED AND ULTIMATELY will not have any positive impact on dengue caseload but also
cause a huge panic for masses from Govt side itself. However, policy makers and health
planner must design an "EVIDANCE-BASED, SUSTAINABLE AND COMMUNITY FRIENDLY"
interventions for dengue and vector-borne diseases control in country.
Please Promote this slogan
The copies of all these papers are available and if anyone is interested, please send e-mail
mukasbilumm@gmail.com (Muhammad Mukhtar. Senior Vector Control Specialist)
.
Muhammad Mukhtar. Senior Vector Control Specialist. Cabinet Secretariat. Govt. of Pakistan. Mukasbilumm@gmail.com