18 November 2019 – The Ministry of National Health Services, Regulations and Coordination (MNHSR&C) of Pakistan reported 2395 new cases of dengue fever during epidemiologic week 46 (November 10 – 16) of 2019. The majority of the new cases, 1731, are reported from Sindh (72.2%), followed by 281 cases in the Islamabad Capital Territory (11.7%), 240 cases in Punjab (10%), 136 cases in Khyber-Pakhtunkhwa (KP) (5.6%) and only five and two cases in Baluchistan and AJK respectively. The total number of dengue cases reported this year are 49 587 including 79 associated death (with Case Fatality Ratio, CRF, of 0.2%) from all the provinces and Azad Jammu and Kashmir (AJK) except for Gilgit-Baltistan. The highest number of deaths during 2019 are reported from Sindh (33, CFR 0.24%) followed by Islamabad (22, CFR 0.16%) and Punjab (20, CFR 0.2%). The districts reporting most of the dengue cases are Islamabad (ICT), Karachi, Peshawar, Rawalpindi, Lasbela and Muzaffarabad.
The data reported by the MNHSR&C for epidemiologic weeks 45 (3 – 9 November 2019) and 46 (10 – 16 November 2019) shows a declining trend in the number of new dengue cases in all regions except Sindh. During the week 45, the total number of new cases in all regions was 2935 compared to 2395 new cases in week 46 showing an 18.4% decline. But the actual decline in other regions is masked by an increase in the number of new cases in Sindh province during week 46 (1731 new cases) compared to 1588 cases reported in week 45. During week 46, the total number of new reported cases in Islamabad, Punjab, KP, Baluchistan and AJK are 664 compared to 1347 cases reported during week 45, which is around 50% reduction. The declining trend in the number of new cases shows that outbreak surveillance, prevention and control measures have started showing results in most of the regions. However, the number of cases in Sindh are still showing an increasing trend.
The federal ministry and provincial health departments are implementing control measures with the support of WHO and other partners to limit the spread of this outbreak which has reached most of the country. At the federal level, an Emergency Operations Center (EOC) at the National Institute of Health (NIH) is monitoring the disease situation on a daily basis. Standard guidelines for case management were shared and formal as well as informal trainings are being conducted. Based on vector surveillance and larvae indices, areas in the most affected district of Rawalpindi were categorized into three zones for implementation of control measures. Areas with house index above nine were labelled as a top zones (red), areas that scored above seven were labeled as second zones and areas above five as third zones. All these areas were considered above threshold of active transmission and control measures were implemented proactively to control the larvae and obstruct the transmission of the virus. The private health sector was also involved and it allocated designated beds/wards for dengue case management. Extensive social mobilization, community engagement and vector control activities are being undertaken in all the affected and neighboring areas with the involvement of relevant line departments and stakeholders.
WHO continues to provide leadership and support to the health authorities and partners while conducting activities to mitigate the outbreak and reduce disease morbidity and mortality. WHO and the MNHSR&C continue to monitor outbreak trends to promptly investigate and respond to all alerts for sustained control of the disease.