Presentation Sudan 03

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    VECTOR BORNE DISEASESIN PAKISTAN

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    DISEASE VECTORS IN PAKISTAN Pakistan being a sub-tropical country has a rich

    fauna of disease vectors including mosquitoes,sandflies, houseflies, biting midges, and other

    dipterous flies. In addition there are soft ticks, hard ticks, lice, mites,

    fleas, cockroaches, bed bugs which, account fornumber of vector born diseases includingarboviruses.

    Research on vector borne diseases is sketchy acceptfor few. Major vector borne diseases in the countryinclude malaria, leishmaniasis.

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    MAJOR VECTOR BORNE

    DISEASESMALARIA Malaria is by far the major vector borne diseases in the

    country.

    Malaria in Pakistan is typically unstable.

    Both Plasmodium falciparumand Plasmodium vivaxare

    widely distributed in Pakistan.

    Major transmission period is post monsoon i.e. from Julythrough November.

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    API/1000 population

    4.0 & above

    1.6 3.9

    1.0 1.5

    Less than 1.0

    No data available

    N

    S

    Malaria Control Programme - 2001 Data

    Malaria Annual Parasite Incidence (API)/1000 Population byDistrict

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    Mosquito Species and Malaria

    Vectors in Pakistan There are over 22 anopheline species and sub-

    species so far recorded from Pakistan

    Anopheles culicifaciesand An. Stephensiare theprimary malaria vectors

    Anopheles culicifaciesis considered to be the most

    important vector in the rural areas and Anophelesstephensi) in the urban areas.

    Both species are endophilic and chiefly zoophilic

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    LESIHANIASIS Leishmaniasis is the second major vector borne

    disease

    Prevalence of leishmaniasis is diffuse & wide spread

    Three types of leishmaniasis are encountered

    - ZCL found in the southwestern region

    - ACL is seen in diffused foci in central region

    - VL is endemic in the Northeastern Region

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    Major epidemics of leishmaniasis inPakistan

    Year City Province No. of cases

    1935 Quetta Baluchistan Un-known

    1971-72 Multan Punjab 2,500

    1974 Army Personnel

    (ZCL)

    Baluchistan 892

    1975 Army Personnel

    (ZCL)

    Baluchistan 502

    1977-81 Uthal (ZCL) Baluchistan 700

    2001 Kurrum Agency

    (ACL)

    NWFP (FATA) 1200

    2001 Larkana, Dadu

    (ZCL)

    Sindh 11,700

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    SANDFLY FAUNA OF PAKISTAN

    Sub genus

    Phlebotomus

    Paraphlebotomus

    Larroussius

    Adlerius

    Euphlebotomus

    Anaphlebotomus

    Species

    papatasi

    alexandri: nuri: sergenti

    kandelakii burneyi, keshishiani;major

    salangensis, hindustanicus

    argentipes

    colabaensisIn addition 10 species of

    Sergentomyia reported.

    (Munir et al 1987, 1994)

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    VECTORS OF LEISHMANIASIS

    ZCL: P.papatasi, P. salehi

    ACL: P.sergenti

    VL: P. hindustanicus (AJK)

    P. Keshishiani (Northern Areas)

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    CCHF IN PAKISTAN

    CCHF is and endemic tick-borne viral

    disease.

    Geographical distribution includes the cold,

    arid regions of Pakistan.

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    Vectors of CCHF

    Ticks belonging to the Genus Haemaphysalisand Hyalomma were the dominant speciescollected from domestic animals during CCHFout-breaks in Baluchistan, but virus could not beisolated.

    Further studies are required to study tick faunaand isolation of virus from the ticks to identifyvector species.

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    Major Outbreaks of CCHF inPakistan from 1976-2000

    Rawa

    lpin

    di-1976

    Quetta

    -1978

    Quetta

    -1987

    Sibi

    -1994

    Kohl

    u-1995

    Kohl

    u-1998

    Pesh

    awar

    -1998

    Sibi

    &Que

    tta-2

    000

    Lakk

    iMar

    wat-2

    000

    Pesh

    awar

    -2000

    Loralai

    &Que

    tta-2

    000

    Kara

    chi-2

    000

    Area

    0

    10

    20

    30

    40 No. of Cases No. of Deaths

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    DENGUE HAEMORRHAGIC

    FEVER DHF first reported in Pakistan in 1994 from

    Karachi

    Thousands of adults were affected.

    In 1995 another 1800 cases of PUO reported

    from, Hub district, Lesbella, Baluchistan, 40

    Kilometres from Karachi Dengue type-II Confirmed on serology

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    VECTORS OF DENGUE

    No information is available on the vectors of Denguefrom Pakistan.

    The species recorded from NWFP Pakistan listfollowing species of aedes mosquitoes:

    Aedes albopictus, Aedes albolateralis, Aedes vittatusand Aedes pseudotaeniatus.

    Another survey of mosquitoes in Karachi in 1983

    showed the abundance ofAedes aegypti

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    SCRUB TYPHUS

    First out-break reported in Pakistan in 1961in Sialkot and then in 1967 from Kaghan

    Valley, Gilgit, Multan and Lahore.

    The vector species reported was Trombicula

    delinese.

    No recent studies.

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    INSECTICIDES IN USE

    INDOOR RESIDUAL SPRAYING

    Organochlorines

    DDT: 1963-79 BHC: 1972-1983

    Organophosphate

    Malathion: 1984-97

    Pyrethroids

    Deltamethrin: 1998 till date

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    Larvicides

    Following larvicides belonging to

    Organophosphates are in use since 1995

    Temephos 500-E

    Fenthion

    ITN S d i F Vill

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    ITN Study in Four Villagesof Sind

    Odds Ratio (O.R.) - protective effect of bednet useagainst falciparum malaria

    - In children below 5 yrs ____ 0.22 (0.05 - 0.9)(significance level0.016)

    - In patients above 5 yrs ____ 0.46 (0.2 - 1.07)

    (significance level

    0.072) -- not significant

    - In all age groups _________ 0.36 (0.17 - 0.73)

    (significance level0.003)

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    RESISTANCE STATUS OFMALARIA VECTORS

    Anopheles culicifacies andAnopheles

    stephensi are resistant to Organochlorines

    (DDT and Dieldrin/BHC)

    Anopheles stephensi resistant to

    Organophosphate (Malathion)

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    THANK YOU