miércoles, 9 de agosto de 2017



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Published Date: 2017-08-09 08:31:31
Subject: PRO/EDR> Chikungunya (25): Asia (Pakistan)
Archive Number: 20170809.5235254
A ProMED-mail post
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International Society for Infectious Diseases

In this posting:
[1] Sindh (Tharparkar)
[2] Khyber Paktunkhwa (Hazara)

[1] Sindh (Tharparkar)
Date: Tue 8 Aug 2017
Source: Dawn [edited]

A special team of doctors rushed to Tharparkar [Sindh] on [Mon 7 Aug 2017] amid reports of an outbreak of chikungunya in the arid region although Sindh health authorities sought to downplay the threat from the viral disease.

A total of 78 positive cases of chikungunya had been reported in Tharparkar so far since January to August [2017]. Director of malaria control programme Dr Nahid Jamali and dengue control programme manager Dr Rasheed Shaikh, who were part of the team, said they had arrived in Thar to assess the situation. "There is no outbreak of chikungunya but yes, there are 516 suspected cases of the viral disease reported in Tharparkar district since January to [6 Aug 2017]," said Dr Shaikh. He said that out of the 516 cases, 78 were confirmed as positive cases of chikungunya following their laboratory tests carried out at Islamabad-based National Institute of Health (NIH).

Sources said that 42 and 62 suspected cases were reported in July and August this year [2017] respectively, and of them 12 were tested as positive for chikungunya. Chikungunya is a mosquito-borne virus transmitted to humans by infected mosquitoes. What worries provincial health authorities is the fact that there is confirmed presence of larvae in water inside Thar villages; the region has been receiving moderate to heavy rainfall over the past month.

Rainfall is considered a blessing for the rain-dependent Tharparkar district, which has turned green after years of dry spell. Villagers stored water in their tanks for drinking purposes and for their livestock. Considering the presence of larvae in stagnant water, health authorities feel that it is essential to exterminate larvae growth but it could not be done right now as livestock is their main source of livelihood and wasting rainwater could jeopardise their economic assets.

The 1st case of chikungunya in Tharparkar was confirmed in a patient who was a resident of Chhachhro but was working in a factory in Saudabad, Karachi, according to a health officer. His travelling history showed he was infected in Karachi but the case was reported in Tharparkar district on [4 Apr 2017]. Dr Jamali told Dawn that since the community was storing water in their tanks for humans as well as for animals, it seemed difficult to start larvicidal (extermination of larvae) activity.

"The community needs health education in view of the fact that they are themselves contributing to breeding this vector due to their socio-economic compulsions," she said. "For the community this water is to be used until next year's [2018] rainfall. There is flare-up in cases between July and August alone, otherwise, the situation remained normal before that period," she added.

Therefore, she said, the community was advised how to cover the water meant for human consumption so that infection could be avoided that could otherwise cause transmission of this illness. Health authorities believed that while vector of dengue could lead to death, chikungunya caused severe joint pain. Unlike dengue, it was in no way fatal but it needed to be controlled.

According to Dr Shaikh, 3400 suspected chikungunya cases have been reported from across Sindh so far. The affected areas include the provincial capital [Karachi].

Tharparkar's health facilities are mostly managed by People's Primary Healthcare Initiative and general practitioners also serve in large numbers. The area's doctors in government facilities are treating every high-grade fever as chikungunya, which has caused panic in the area. To a question, Dr Shaikh said that the blood samples were being preserved at government facilities and its cold chain was being maintained till it reached NIH Islamabad. He denied that the samples could be contaminated during transportation from an area like Thar to Islamabad and said that evaluation of cases continued in a normal manner and cases were being reported through normal channel of focal persons for chikungunya. Our Mithi [capital of Tharparkar district] correspondent adds: Sindh Minister for Health Dr Sikandar Ali Mandhro was scheduled to arrive in Thar today [Tue 8 Aug 2017] amid reports of chikungunya outbreak.

[Byline: Mohammad Hussain Khan]
Communicated by:

[2] Khyber Paktunkhwa (Hazara)
Date: Sat 5 Aug 2017
Source: The Express Tribune [edited]

Chikungunya virus has claimed the lives of 2 siblings in the span of a week, spreading fear of an epidemic in Haripur city [Hazara, Khyber Paktunkhwa].

The virus has so far mostly been reported in the coastal belt of the country; however, recently, some infected people travelling from Karachi brought the virus with them to the hilly areas.

Recently, 3 busloads of people came to attend a wedding in the Abbasia Mohalla [Bahawalpur district, Punjab]. Some of the guests were carrying, apart from their luggage, the chikungunya virus, said Tehsil [sub-district] Headquarters (THQ) Hospital in-charge Dr Faisal Khan, while sharing details of his investigations.

"Until recently, there were no cases of chikungunya in Haripur. However, some people coming from Karachi to attend a wedding have spread the virus," he claimed.

As a result, 2 children were infected by the virus and subsequently died, he said. The family of the deceased children were devastated, while the community is gripped by panic that the virus may spread.

Over the last fortnight, a large number of people, mostly elderly and children, have been brought to district and tehsil hospitals while displaying symptoms of chikungunya, doctors confirmed.

Officials stated that almost 70 percent of the population of Khoi Meera Village of Khanpur [Bahawalpur] had been affected by the virus, while there were widespread complaints of people suffering from high temperatures and severe body pain and headaches.

Doctors at THQ Hospital were trying to convince the people, in vain, that the life span of the virus was between 5 to 7 days and that the only medication was complete bed rest, consuming lots of fresh juices, and adopting a healthy diet with painkillers.

There is no commercial chikungunya vaccine, health officials said. However, residents of Khoi Meera Village and Abbasia Mohalla were running from one hospital to another seeking relief.

Meanwhile, Haripur's District Health Officer Dr Mushtaq Khan Tanoli said the doctors and paramedics were trying to convince the people that the virus was not fatal.

"We have also distributed as much mosquito repellent as we could from our own resources," the top doctor of Haripur said, adding that the town administration too has handed out some mosquito nets while urging the public to use them.

"We have dispatched medical teams to investigate the intensity of the chikungunya outbreak in the areas surrounding Haripur. They will collect blood samples and also inform the people about the symptoms and prevention of the disease," Dr Tanoli said.

He said that the civil administration has been urged to carry out anti-mosquito spraying and to try to drain out stagnant water to avoid spawning.

[Byline: Yawar Hayat]

Communicated by:

[Since the 1st cases of chikungunya were reported from Sindh in December 2016, other parts of the country including Punjab, Balochistan, and Khyber Pakhtunkhwa (KP) have also reported positive cases. To date, 32 out of 72 suspected cases from the KP province have tested positive for chikungunya infections (personal communication). - Mod.UBA

Maps of Pakistan can be seen at http://pakistanmap.facts.co/pakistanmapof/PakistanAdministrativeMap.jpg and http://healthmap.org/promed/p/140. - Sr.Tech.Ed.MJ]

See Also

Chikungunya (24): Asia (Pakistan) 20170726.5205157
Chikungunya (23): Asia (Bangladesh), case numbers 20170711.5165290
Chikungunya (22) - Americas, Asia 20170704.5149989
Chikungunya (21) - Americas, Asia, observations, research 20170626.5132080
Chikungunya (20): Asia (Pakistan) 20170623.5127317
Chikungunya (19): Americas, Asia, observations, research 20170610.5096983
Chikungunya (19): Americas, Asia, observations, research 20170610.5096983
Chikungunya (17): Asia (Bangladesh) 20170518.5044158
Chikungunya (16): Asia (Bangladesh) 20170515.5037500
Chikungunya (15): Asia (Pakistan) 20170511.5020435
Chikungunya (14): Asia (Pakistan) 20170507.5019416
Chikungunya (13): Asia (Pakistan) 20170429.5000142
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Chikungunya (11): Asia (Pakistan) 20170405.4947304
Chikungunya (10): Asia (Nepal) 20170402.4942966
Chikungunya (09): Asia (Pakistan) 20170327.4929182
Chikungunya (08): Asia (Pakistan) 20170316.4901816
Chikungunya (07): Asia (Pakistan) WHO 20170302.4870168
Chikungunya (06): Americas, Asia, research 20170206.4817959
Chikungunya (05): Asia (Pakistan) 20170120.4774934
Chikungunya (04): Asia (Pakistan) spread 20170116.4767440
Chikungunya (03): Asia (Pakistan) 20170110.4754019
Chikungunya (02): Asia (Pakistan) 20170107.4742890
Chikungunya (01): Asia (Pakistan) 20170102.4731668

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