# 5010
Two updates today from the World Health Organization on the ongoing outbreaks of several infectious diseases in Pakistan.
First, Cholera – which like in Africa and now Haiti, has also been sporadically reported in the flood affected provinces of Sindh, Punjab and Khyber Pakhtunkhwa.
Cholera in Pakistan
25 October 2010 -- On 12 October 2010, the Ministry of Health in Pakistan reported laboratory confirmation of 99 cases of Vibrio cholera 01 in the country. These cases were laboratory-confirmed by the National Institute of Health since the beginning of the flood until 30 September 2010. These cases have been reported sporadically from a wide geographical area in the flood-affected provinces of Sindh, Punjab and Khyber Pakhtunkhwa.
The Ministry of Health in Pakistan supported by the World Health Organization and other local and international partners are collaborating closely to prevent outbreaks of any disease, including cholera, and treat people affected by such illnesses. More than 60 diarrhoeal treatment centres are either operating or are soon to start functioning in the 46 most affected districts of the country.
Diarrhoeal diseases including cholera are among the most reported health conditions in many locations affected by the recent floods disaster in the country.
FOR MORE INFORMATION
WHO cholera Fact sheet
WHO Pakistan web site
Next, since the end of September we’ve been watching reports of heightened transmission of CCHF – normally a tick-borne illness – being reported in several areas of Pakistan.
As you can see from this WHO map, CCHF is not uncommon in this part of the world.
While I’ve been tempted to blog on this outbreak for a couple of weeks, quite frankly the reports I’ve seen have been inconsistent and confusing.
Over the past month we’ve suggestions of nosocomial transmission among health care workers, denials, retractions, and revisions of numbers as these ProMed Mail dispatches demonstrate.
PRO/AH/EDR> Crimean-Congo hem. fever - Pakistan (09): (NW)
PRO/AH/EDR> Crimean-Congo hem. fever - Pakistan (08): (PB), not
PRO/AH/EDR> Crimean-Congo hem. fever - Pakistan (07): revised data, WHO
PRO/AH/EDR> Crimean-Congo hem. fever - Pakistan (06): (PB)
PRO/AH/EDR> Crimean-Congo hem. fever - Pakistan (05): (NW)
PRO/AH/EDR> Crimean-Congo hem. fever - Pakistan (04): (PB)
PRO/AH/EDR> Crimean-Congo hem. fever - Pakistan (03): (PB) nosocomial
Today, a rather generic update from the WHO that suffers from a lack of detail.
Nothing is said about exactly where these cases occurred, or about the mode of transmission, leaving much uncertainty.
Things are, however, still in a state of flux in the wake of the unprecedented flooding disaster last month in that nation, and so some of this ambiguity may be understandable.
Crimean-Congo haemorrhagic fever (CCHF) and Dengue in Pakistan
25 October 2010 -- As of 15 October, the IHR National Focal Point, Ministry of Health (MoH), Pakistan, has notified WHO of 26 cases, including 3 deaths, of Crimean-Congo haemorrhagic fever (CCHF). In addition, over 1500 laboratory-confirmed cases of dengue fever including 15 deaths have also been reported from Pakistan so far.
Both CCHF and dengue fever are endemic in Pakistan with seasonal rise in cases. However, recently, the transmission of both CCHF and dengue fever has intensified in the country with increased incidence and geographic expansion. The recent Pakistan floods may have contributed to this upsurge as a result of changes in risk factors for these diseases.
Operational response
The MoH has scaled up response activities to prevent and mitigate CCHF and dengue fever, including awareness-raising campaigns on exposure risks and preventive measures for the general public, strengthening clinical and case management of patients with haemorrhagic fevers, stockpiling appropriate drugs and personal protective equipment, and implementing targeted vector control activities.
Upon request from the MoH in Pakistan, WHO is mobilizing experts in the clinical management of severe dengue fever and in infection control in health care settings through the Global Outbreak Alert and Response Network (GOARN). WHO is also assisting the country with resource mobilization, strengthening disease surveillance, laboratory diagnostics, and training of health care providers.
FOR MORE INFORMATION
WHO dengue website
WHO CCHF website
