Fighting the dengue epidemic By Prof Dr Arif Nawaz

Dengue fever has continued to haunt mankind for the last several centuries with historical accounts of this disease from Africa which are between five to six hundred years old. The first outbreaks of dengue fever reached Asia, South America and Africa concurrently in the 1780s. Now this disease is endemic in several regions including Southeast Asia, Latin America, Asia, and the Caribbean; areas with a high vector population of the mosquitoes that causes the disease, theAedes aegypti and Aedes albopictus. Dengue fever has become aprominent infectious disease with outbreaks in as many as 120 countries of the world. The annual disease burden of this disease has reached 40 million with dengue becoming the second-most prevalent mosquito-borne infection after malaria in recent decades.

The illness causes significant morbidity with the cases of dengue haemorrhagic fever (which is a complicated form of this disease) touching several thousand a year. This disease was eliminated from Pakistan in the 1970s only to reappear in 1994. The recent epidemic of dengue fever in the country has been one of the biggest in the history of this country. Attention has been refocused on this condition due to the scale of devastation it has caused, in terms of health care related and economic costs.

Several countries including Sri Lanka have taken measures including case surveillance, research and interventions designed to eradicate the vector for this disease. Unfortunately, Pakistan has lagged behind in this respect. Health and economic research specific to dengue is urgently needed to ensure informed decision-making on the various options for controlling and preventing this disease. Several organisations, including various academic institutions and non-governmental organisations have initiated projects designed to address the menace of dengue fever. One such effort is the research being conducted by the Fatima Memorial System and Hospital in Lahore in collaboration with the University of Punjab.

While significant effort is on at the global level to institutionalise health research within the health care systems of countries, the developing countries are not benefitting from these endeavours owing to their severe health research capacity constraints. Pakistan too has to date not benefitted from the global initiatives to strengthen health research in developing countries. More than ever before our country needs to develop informed policies and implement evidence-based interventions to protect and promote the health of its people, curtail wasteful expenditure and thus accelerate its economic development.

The options for controlling this disease at this time include vector control and optimal medical therapy for the effected patients. Both these interventions are limited in several ways in their ability to eliminate this disease. A dengue vaccine would fill a substantial need as almost 3.6 billion people are at risk from this potentially fatal infection. Vaccines are in the process of development at this time and preliminary trials have given us hope of being able to control this disease. Development of vaccines has, however, been complicated by the need to immunise against all four serotypes of this virus simultaneously. There are currently at least six vaccines in various phases of clinical trials. It is anticipated that a safe and effective vaccines will be licensed for dengue fever in the next five years.

Source: http://tribune.com.pk/story/273975/fighting-the-dengue-epidemic/

Dawn Editorial - Crime and terrorism + Polio Cases

MILITANCY and terrorism in Pakistan is a hydra-headed monster. Experience has shown that even when the security forces achieve success in one area, their efforts do not succeed in killing the monster. By necessity, therefore, countering the threat requires concerted, multi-pronged efforts that target various aspects simultaneously, across the law and order spectrum. How crucial this last aspect is can be gauged from increasing evidence about links between the Pakistani Taliban and street crime as described in a recent news report. Increasingly, insurgents are raising funds for their activities through bank heists, kidnappings for ransom and extortion. Drawing upon a network of malcontents and for-hire criminals across the country, they are blamed for masterminding or carrying out crimes to fund their insurgency. In doing so, they add to the crime wave and contribute to further erosion of the people`s confidence in the state and intensification of fear. The Taliban hand, through the `Black Night` group, is said to have been behind a June raid on a Dera Ismail Khan bank; in Karachi, the Taliban are thought to have been behind three of four bank robberies carried out this year which netted $2.3m. Similar links have been found in numerous abduction and extortion cases.

The shift in sources is a simple equation. US and Pakistani military offensives have killed or sidelined many mid-level and senior commanders who were, in a number of cases, men with links to international funding networks. Meanwhile, greater scrutiny of money transfers has made it harder to send funds around the world. Countering this phenomenon will require cooperation and intelligence-sharing between the civil and military law-enforcement agencies. Only if both are equally well-equipped and trained, and are working in tandem to combat a common enemy, can there be any hope. Without that, both arms of the security forces will continue to address the problem in a piecemeal and ultimately ineffective fashion. As for the Taliban, the logic under which they justify their turning to crime is despicable. Although they advertise their war as being one of a religious hue, their tactics expose the hollowness of their ideology.

Source: http://www.dawn.com/2011/10/15/crime-and-terrorism.html

New polio cases

A REPORT in this newspaper on Thursday says five fresh polio cases have been detected in Balochistan, bringing the number of children affected by the virus in Pakistan this year to over 100. Balochistan leads this unfortunate count with nearly 50 cases. Another alarming development is that a boy in Karachi`s Gadap Town, who reportedly received anti-polio drops seven times, is among the recent victims. It is worrisome that there are increasing reports of children in different parts of the country contracting polio despite receiving numerous doses of the vaccine. This raises questions about the efficacy of the polio vaccine; perhaps there are issues with the way it is being stored and handled. Reports that the virus has been detec-ted in Multan, Lahore and Rawalpindi are also cause for concern.

The state`s health authorities as well as international experts need to investigate why there have been cases of infection despite the vaccine being administered multiple times. If the vaccine`s efficacy has been compromised, the problem must be rectified immediately. The state also needs to monitor migrant and mobile populations who play a major role in transmitting the virus from high-risk to hitherto `clean` zones. For example, the highest number of polio cases was reported from Balochistan`s Qilla Abdullah district which borders Afghanistan. Pakistan and Afghanistan — both endemic countries — re-infect each other due to the regular movement of people between them. The World Health Organisation has recommended that mobile and migrant populations be mapped in order to keep track of polio`s spread. The state needs to implement this recommendation to the fullest and plug the loopholes. Failure to do so will have consequences apart from the health risk: the World Bank has warned that a $40m grant will be converted into a loan due to Pakistan`s poor response to the fight against polio.

Source: http://www.dawn.com/2011/10/15/new-polio-cases.html