Associations of the COVID-19 pandemic with the reported incidence of important endemic infectious disease agents and syndromes in Pakistan.

BACKGROUND: Persons in Pakistan have suffered from various infectious diseases over the years, each impacted by various factors including climate change, seasonality, geopolitics, and resource availability. The COVID-19 pandemic is another complicating factor, with changes in the reported incidence of endemic infectious diseases and related syndromes under surveillance. METHODS: We assessed the monthly incidence of eight important infectious diseases/syndromes: acute upper respiratory infection (AURI), viral hepatitis, malaria, pneumonia, diarrhea, typhoid fever, measles, and neonatal tetanus (NNT), before and after the onset of the COVID-19 pandemic. Administrative health data of monthly reported cases of these diseases/syndromes from all five provinces/regions of Pakistan for a 3-year interval (March 2018-February 2021) were analyzed using an interrupted time series approach. Reported monthly incidence for each infectious disease agent or syndrome and COVID-19 were subjected to time series visualization. Spearman's rank correlation coefficient between each infectious disease/syndrome and COVID-19 was calculated and median case numbers of each disease before and after the onset of the COVID-19 pandemic were compared using a Wilcoxon signed-rank test. Subsequently, a generalized linear negative binomial regression model was developed to determine the association between reported cases of each disease and COVID-19. RESULTS: In late February 2020, concurrent with the start of COVID-19, in all provinces, there were decreases in the reported incidence of the following diseases: AURI, pneumonia, hepatitis, diarrhea, typhoid, and measles. In contrast, the incidence of COVID was negatively associated with the reported incidence of NNT only in Punjab and Sindh, but not in Khyber Pakhtunkhwa (KPK), Balochistan, or Azad Jammu & Kashmir (AJK) & Gilgit Baltistan (GB). Similarly, COVID-19 was associated with a lowered incidence of malaria in Punjab, Sindh, and AJK & GB, but not in KPK and Balochistan. CONCLUSIONS: COVID-19 was associated with a decreased reported incidence of most infectious diseases/syndromes studied in most provinces of Pakistan. However, exceptions included NNT in KPK, Balochistan and AJK & GB, and malaria in KPK and Balochistan. This general trend was attributed to a combination of resource diversion, misdiagnosis, misclassification, misinformation, and seasonal patterns of each disease.

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.