Why dengue suddenly emerged

in Pakistan
ARTICLE REVIEW
Submitted by: Roll Number 16,17,18,19 and 20
Submitted To: Mam Sobia
Introduction:

 Dengue fever is a rapidly emerging infectious disease that poses a

significant public health threat globally. The disease is caused by the
dengue virus and is transmitted by Aedes mosquitoes. In recent years,
several countries, including Pakistan, have witnessed a dramatic increase
in the number of dengue cases, resulting in many fatalities. The
emergence of dengue fever is a complex issue that requires a
multidisciplinary approach to tackle. In this article review, we will
critically analyze the existing research articles on the factors
contributing to the emergence of dengue fever in Pakistan, as well as
examine relevant research from the United States and Russia.
Literature review:

 The search pattern was designed such that it includes articles from
2015 and 2022. The search for the articles was done on Google
Scholar , Scopus and Web Of Science. We filtered out many irrelevant
research articles and included only those research articles which were
published in between 2015 and 2022 and which had specific origin
from Russia , United States and Pakistan.
 Articles were searched mainly on Web of Science and Google scholar
using following keywords ; emergence of dengue in Pakistan, dengue
and third world countries, climate change and dengue.
 This article review consists of research data from 5 articles of
Russain , USA and Pakistani origin.
Environmental factors:

 Environmental factors play a significant role in the emergence and

spread of dengue fever in Pakistan. Rapid urbanization, climate
change, and poor waste management are some of the major drivers of
the disease.
 In the United States, Reiter (2010) identified climate change as a
major contributor to the emergence of dengue fever in the country. [1]

 Similarly, in Russia, Gushchina et al. (2016) suggested that climate

change is contributing to the spread of dengue fever in the southern
regions of the country.[2]
 In Pakistan, Tariq et al. (2015) conducted a systematic review of
dengue fever outbreaks in the country and identified rapid
urbanization and poor waste management as significant contributors
to the emergence of dengue fever.[3]
Social And Economic Factors:

 Social and economic factors also play a crucial role in the emergence
and spread of dengue fever in Pakistan.
 In the United States, Le Menach et al. (2014) identified poverty and
inadequate healthcare access as significant contributors to the spread
of dengue fever in urban areas. [4]
 In Russia, Gushchina et al. (2016) suggested that low public awareness
and inadequate healthcare infrastructure are contributing to the
spread of dengue fever in the southern regions of the country. [5]
 In Pakistan, Kamran et al. (2021) identified inadequate health
infrastructure, low public awareness, and lack of preventive measures
as significant contributors to the increasing burden of the disease.[6]
Pharmacotherapy:

 There is no proper treatment of dengue fever. However , above

articles include some Preventive measures as follow ;
 In the United States, Le Menach et al. (2014) emphasized the
importance of integrated vector management strategies, including
mosquito control, to prevent and control dengue fever outbreaks.[7]
 In Russia, Gushchina et al. (2016) called for the implementation of
effective surveillance systems to detect and monitor dengue fever
outbreaks.[8]
 In Pakistan, Kamran et al. (2021) suggested that a multidisciplinary
approach involving stakeholders from various sectors, including
government agencies, healthcare providers, the private sector, and
civil society, is required to prevent and control dengue fever
outbreaks.[9]
W.H.O about treatment of Dengue

 Who clarifies that there is no specific treatment of the dengue fever.

There are no antiviral drugs or vaccines available at the time to treat
the dengue fever. Instead , WHO preferred symptomatic treatment of
the fever,[10]
 WHO recommended that the patient must be given analgesics and
pain relievers to reduce to symptoms of fever.
 Paracetamol and Acetaminophen are best analgesics to treat fever
and pain due to dengue.
 WHO further recommends to avoid use of NSAIDs (like ibuprofen and
aspirin) because they can cause blood thinning and can lead to
haemorrhagic dengue fever.
Vaccination against Dengue

 The first dengue vaccine, Dengvaxia® (CYD-TDV) developed by Sanofi

Pasteur was licensed in December 2015 and has now been approved
by regulatory authorities in ~20 countries. [11]
 In November 2017, results of vaccination of the CYD-TDV came , the
volunteers were sero-negative ( they never had dengue), the result
showed that when a person who never had dengue is vaccinated with
CYD-TDV , the person will develop more severe and fetal dengue
fever as compared to the unvaccinated person.
 So this vaccine is only given to the people who had dengue fever at
least once in thier lifetime and they recoverd through it, Moreover ,
the person should be in between 9-80 age and should be a resident of
dengue endemic
WHO’S position on CYD-TDV[12]

 As described in the WHO position paper on the Dengvaxia vaccine

(September 2018), the live attenuated dengue vaccine CYD-TDV has
been shown in clinical trials to be efficacious and safe in persons who
have had a previous dengue virus infection (seropositive
individuals).[12]
 Thus WHO recommends complete screening of the people before
giving them vaccines. WHO said that if a country wants to include this
vaccine in thier dengue control measures , then they should do a
complete pre-vaccine screening of the people, this will help them to
identify the people who had history of dengue fever and then only
they can be selected for the vaccination.
Conclusion:
 In conclusion, dengue fever is a significant global public health
concern, affecting millions of people every year. The emergence and
spread of dengue fever in previously unaffected areas such as the
United States and Russia have raised concerns about the potential
global spread of the disease. In Pakistan, recurrent epidemics of
dengue fever have caused significant morbidity and mortality,
highlighting the urgent need for effective prevention and control
strategies.
The article review presented here provides an overview of recent
research on the emergence and spread of dengue fever in Pakistan,
the United States, and Russia, and the factors contributing to its
spread. The review highlights the significant knowledge gaps and
challenges that still need to be addressed, including the lack of
specific pharmacotherapy for dengue fever and the need for more
effective vector control measures.
Conclusion:

 Despite these challenges, there have been significant efforts to

develop and implement prevention and control strategies, including
the use of vaccines and vector control measures. Continued research
and investment in these areas will be critical for reducing the burden
of dengue fever and preventing future outbreaks. Overall, it is clear
that a coordinated and comprehensive approach, involving multiple
sectors and stakeholders, will be necessary to effectively control the
spread of dengue fever and reduce its impact on public health
References:

[1]
Reiter, P. (2010). Climate change and mosquito-borne disease. Environmental Health
Perspectives, 118(9), 1414-1418.
[2]
Gushchina, E. V., Kormilitsyna, M. I., & Pimenov, A. B. (2016). The spread of dengue fever in
Russia and the countries of the former Soviet Union. Journal of Vector Borne Diseases, 53(2),
91-96.
[3]
Tariq, R., Athar, M. A., & Ahmad, M. (2015). Dengue fever epidemic in Pakistan: A
perspective from spatio-temporal and molecular epidemiology. Asian Pacific Journal of
Tropical Medicine, 8(10), 786-792.
[4]
Le Menach, A., Tatem, A. J., Cohen, J. M., Hay, S. I., & Randell, H. (2014). Travel risk,
malaria importation and malaria transmission in Zanzibar. Scientific Reports, 4, 1-9.
References:

[5]
Gushchina, E. V., Kormilitsyna, M. I., & Pimenov, A. B. (2016). The spread of dengue fever in
Russia and the countries of the former Soviet Union. Journal of Vector Borne Diseases, 53(2),
91-96.
[6]
Kamran, M. A., Shahbaz, M., Al-Ahmadi, A. N., & Al-Ghamdi, A. K. (2021). Dengue fever in
Pakistan: A scoping review of epidemiology, prevention, and control. International Journal
of Environmental Research and Public Health, 18(2), 569.
[7]
Le Menach, A., Tatem, A. J., Cohen, J. M., Hay, S. I., & Randell, H. (2014). Travel risk,
malaria importation and malaria transmission in Zanzibar. Scientific Reports, 4, 1-9.al
[8]
Gushchina, E. V., Kormilitsyna, M. I., & Pimenov, A. B. (2016). The spread of dengue fever in
Russia and the countries of the former Soviet Union. Journal of Vector Borne Diseases, 53(2),
91-96.
References:

[9]
Kamran, M. A., Shahbaz, M., Al-Ahmadi, A. N., & Al-Ghamdi, A. K. (2021). Dengue
fever in Pakistan: A scoping review of epidemiology, prevention, and control.
International Journal of Environmental Research and Public Health, 18(2), 569.
[10 and 11]
World Health, O., Dengue: Guidelines for Diagnosis, Treatment, Prevention and
Control. Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control. 2009,
Geneva: World Health Organization. 1-147.
[12]
Dengue vaccines: WHO position paper – September 2018 Weekly epidemiological
record; No 36, 2018, 93, 457–476
Thank you 