VECTOR BORNE DISEASES IN PAKISTAN

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 for number of vector born diseases including arboviruses. Research on vector borne diseases is sketchy accept for few. Major vector borne diseases in the country include malaria, leishmaniasis.

MAJOR VECTOR BORNE DISEASES

MALARIA

Malaria is by far the major vector borne diseases in the country.

Malaria in Pakistan is typically unstable.

Both Plasmodium falciparum and Plasmodium vivax are widely distributed in Pakistan. Major transmission period is post monsoon i.e. from July through November.

Malaria Control Programme - 2001 Data

Malaria Annual Parasite Incidence (API)/1000 Population by District

N

API/1000 population
4.0 & above
1.6 3.9 1.0 1.5 Less than 1.0 No data available

Mosquito Species and Malaria Vectors in Pakistan

There are over 22 anopheline species and subspecies so far recorded from Pakistan
Anopheles culicifacies and An. Stephensi are the primary malaria vectors Anopheles culicifacies is considered to be the most important vector in the rural areas and Anopheles stephensi) in the urban areas. Both species are endophilic and chiefly zoophilic

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

Major epidemics of leishmaniasis in Pakistan

Year 1935 1974 1975 City Quetta Province Baluchistan Punjab No. of cases Un-known 2,500 892 502 700

1971-72 Multan

Army Personnel Baluchistan (ZCL)

Army Personnel Baluchistan (ZCL) 1977-81 Uthal (ZCL) Baluchistan

2001
2001

Kurrum Agency NWFP (FATA) 1200 (ACL) Larkana, Dadu Sindh 11,700 (ZCL)

SANDFLY FAUNA OF PAKISTAN

Sub genus

Species
papatasi alexandri: nuri: sergenti kandelakii burneyi, keshishiani; major salangensis, hindustanicus argentipes colabaensis In addition 10 species of Sergentomyia reported. (Munir et al 1987, 1994)

Phlebotomus Paraphlebotomus Larroussius

Adlerius Euphlebotomus Anaphlebotomus

VECTORS OF LEISHMANIASIS

ZCL:
ACL: VL:

P.papatasi, P. salehi
P.sergenti P. hindustanicus (AJK) P. Keshishiani (Northern Areas)

CCHF IN PAKISTAN

CCHF is and endemic tick-borne viral disease.

Geographical distribution includes the cold, arid regions of Pakistan.

Vectors of CCHF

Ticks belonging to the Genus Haemaphysalis and Hyalomma were the dominant species collected from domestic animals during CCHF out-breaks in Baluchistan, but virus could not be isolated.
Further studies are required to study tick fauna and isolation of virus from the ticks to identify vector species.

40 30 20 10 0
di in lp a 7 19 6

Major Outbreaks of CCHF in Pakistan from 1976-2000

No. of Cases No. of Deaths

aw

ta et u

7 19

8 u t et

8 19 a-

7 iib S

4 99 1 K

uhl o

5 99 1 K

uhl o

9 19 Pe

8 w ar

9 19 i& ib

8 u ta et -

0 20

0 ar w at

0 00 2 w ha s Pe L

ar

0 20

0 u ta et -

0 20

0 h ac i-

0 00 2

a sh

k La

iM

Q & ai l ra o

ar K

Area

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

VECTORS OF DENGUE

No information is available on the vectors of Dengue from Pakistan.

The species recorded from NWFP Pakistan list following species of aedes mosquitoes: Aedes albopictus, Aedes albolateralis, Aedes vittatus and Aedes pseudotaeniatus. Another survey of mosquitoes in Karachi in 1983 showed the abundance of Aedes aegypti

SCRUB TYPHUS

First out-break reported in Pakistan in 1961 in Sialkot and then in 1967 from Kaghan Valley, Gilgit, Multan and Lahore.
The vector species reported was Trombicula delinese. No recent studies.

INSECTICIDES IN USE
INDOOR RESIDUAL SPRAYING Organochlorines

DDT: BHC: Malathion: Deltamethrin:

1963-79 1972-1983 1984-97 1998 till date

Organophosphate

Pyrethroids

Larvicides Following larvicides belonging to Organophosphates are in use since 1995

Temephos 500-E Fenthion

ITN Study in Four Villages of Sind

Odds Ratio (O.R.) - protective effect of bednet use against falciparum malaria - In children below 5 yrs ____ 0.22 (0.05 - 0.9) (significance level 0.016) - 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 level 0.003)

Prevalence of Falciparum Malaria in different age groups in ITN Intervention and Control Groups
8 7.1 6 4.4 4 2.3 2 1.6 intervention control

% falciparum cases

5.6

2.1

0 below 5 years above 5 years TOTAL

RESISTANCE STATUS OF MALARIA VECTORS

Anopheles culicifacies and Anopheles stephensi are resistant to Organochlorines (DDT and Dieldrin/BHC)
Anopheles stephensi resistant to Organophosphate (Malathion)

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