Middle East Respiratory Syndrome Corona Virus Alert Verification In Mirpur, Azad Kashmir.

BACKGROUND: Middle East Respiratory-Corona virus (MERS-CoV), SARS like virus, identified in September 2012 in Middle-East. February 2013, an elderly man, who visited Pakistan and KSA, was confirmed as MRS-CoV in UK. A team visited Mirpur to assess current and past SARI trends in major indoor facilities, to explore possible contact of the patient with known or suspected SARI case during his stay in Pakistan and enlist close contacts. METHODS: Review of indoor records in hospitals, interviews with relatives & physicians and active contact tracing using operational case definition. RESULTS: Arrived on 16th December 2012, mostly stayed at daughter's house, visited by relatives, on 19th January, left for KSA accompanied by daughter, developed fever with chills and body aches on 23rd January. On 28th January, arrived London, admitted at City Hospital, Birmingham, subsequently shifted to Manchester Hospital on 6th February 2013, diagnosed as MERS-CoV, expired on 19th February. His son having underlying condition, confirmed as MERS-CoV on 13th February, and expired on 17th February. Daughter developed mild respiratory symptoms, confirmed as MERS-CoV on 16th Feb and recovered. Both have been infected by the Index case. The review of indoor record did not reveal any significant change in SARI trends, the cumulative number of cases for the January -February 2012 and 2013 was 291 and 294 respectively indicating no difference. During his stay in Pakistan, he didn't meet any suspected/ill person. Close contacts were observed and investigated for MERS-CoV, all remained healthy. CONCLUSIONS: The available evidence does not suggest any MERS-CoV transmission to, or from the patient in Pakistan.

Molecular epidemiology of influenza A(H1N1)pdm09 viruses from Pakistan in 2009-2010.

BACKGROUND: In early 2009, a novel influenza A(H1N1) virus that emerged in Mexico and United States rapidly disseminated worldwide. The spread of this virus caused considerable morbidity with over 18000 recorded deaths. The new virus was found to be a reassortant containing gene segments from human, avian and swine influenza viruses. METHODS/RESULTS: The first case of human infection with A(H1N1)pdm09 in Pakistan was detected on 18(th) June 2009. Since then, 262 laboratory-confirmed cases have been detected during various outbreaks with 29 deaths (as of 31(st) August 2010). The peak of the epidemic was observed in December with over 51% of total respiratory cases positive for influenza. Representative isolates from Pakistan viruses were sequenced and analyzed antigenically. Sequence analysis of genes coding for surface glycoproteins HA and NA showed high degree of high levels of sequence identity with corresponding genes of regional viruses circulating South East Asia. All tested viruses were sensitive to Oseltamivir in the Neuraminidase Inhibition assays. CONCLUSIONS: Influenza A(H1N1)pdm09 viruses from Pakistan form a homogenous group of viruses. Their HA genes belong to clade 7 and show antigenic profile similar to the vaccine strain A/California/07/2009. These isolates do not show any amino acid changes indicative of high pathogenicity and virulence. It is imperative to continue monitoring of these viruses for identification of potential variants of high virulence or drug resistance.

Entomological investigations of dengue vectors in epidemic-prone districts of Pakistan during 2006–2010.

Intensive entomological investigations were carried out in seven dengue epidemic-prone districts of Pakistan, classifying them into three geographical regions, viz. southern, central and northern Pakistan. A total of 5132 water habitats from 2136 households in and around dengue-positive houses were sampled. Additionally, 264 samples each at least 30 metres away from dengue-positive houses were also collected from outdoor habitats. Only indoor samples data were used for the estimation of entomological indices. House Index, Container Index and Breteau Index were estimated at 39.42%, 27.96% and 67.20 respectively. Underground water tanks showed the highest (42.38%) positivity, followed by earthen pots (36.97%), drums (33.38%) and the least (4.58%) from discarded containers. From outdoor sites, only 5.05% (n=14) samples were found positive. Aedes aegypti and Aedes albopictus species exhibited a distinct association with different geographical regions. In the south of the country only Ae. aegypti was recorded in all (n=452) positive habitats while in the central part, both Ae. aegypti and Ae. albopictus were reported from 88.2% (n=253) and 11.8% (n=34) of the total 287 positive habitats respectively. In the north/submountainous region, 88.45% (n=628) of 710 positive samples were found infested with Ae. albopictus. Both species showed a significant population-rising trend from September to November, similar to the dengue case-load trend.