New infectious diseases challenge healthcare experts

Karachi: The world faces serious threats from arboviruses – vector borne diseases like dengue, yellow fever, chikungunya, Japanese B encephalitis – and various bacteria such as tuberculosis and pneumonia that have become resistant to nearly every available antibiotic, warned healthcare experts at a symposium organised by Aga Khan University in collaboration with the University of Florida and the American Society for Microbiology.

Arboviruses are endemic in the South Asian region, including India and Bangladesh, and health experts are of the view that Pakistan could also be vulnerable due to the similar climatic conditions and ground realities like poverty, lack of healthcare facilities and insufficient role of government in tackling the diseases.

“Patients with arboviruses show dengue-like symptoms and if they test negative for dengue, they are categorised as patients with unknown fever or a febrile illness,” said Dr Erum Khan, Section Head, Department of Pathology and Laboratory Medicine, AKU while speaking on the occasion.

Sharing further details, Dr Khan revealed that during a study conducted on patients with ‘unknown fever’ in Sindh, 20 to 30 per cent patients complained of dengue-like symptoms whereas their lab tests confirmed them negative for dengue. “This led us to conclude that there may be arbovirus cases in this region. Unfortunately, we lack the diagnostic facilities and the right tools to confirm the actual number of cases,” she added.

Arboviruses can be life threatening if there is a delayed diagnosis. The problem is that nearly every illness in the arboviruses family, shows more or less similar symptoms i.e. fever and a rash in the initial stages and hence goes undiagnosed.

“Our interest is to look for these viruses and differentiate between them so as to identify the actual cause of an infection,” shared Dr Khan.

AKU and the University of Florida are launching a pilot project in Sindh to detect arbovirus cases. Patients with febrile illness from Karachi, Hyderabad, Thatta, Larkana, Sukkur and Mirpurkhas will be recruited and tested for a range of viruses. The findings will be shared with the government to develop a better understanding of arboviruses.

The other health concern that was highlighted at the symposium was antimicrobial or drug resistance. Over time, mutated forms of bacteria are emerging that have become immune to every known antibiotic.

Shedding light on the topic, Dr Rumina Hasan, Professor, Department of Pathology and Laboratory Medicine, AKU, said, “We are losing all we had in our hands. It is like going back to old days when there was no antibiotic available and people would die of minor infections. The situation is very bleak.”

To add to the gravity of the problem, pharmaceutical companies have lost interest in producing antibiotics. It can take up to 10 years to come up with a new antibiotic and if a bacterium adapts to it in a few months, the antibiotic loses its market.”

The reasons why bacteria have mutated so rapidly is the inappropriate and free use, rather abuse of drugs and the poor management of biological wastes at hospitals and microbiological labs.

“Here in Pakistan, we do not enforce drug regulations and most of microbiological labs do not employ bio-safety measures while managing wastes,” said Dr Hasan.

“Government has to play a big role here. Over-the-counter availability of antibiotics needs to be checked and physicians should also be responsible enough not to prescribe antibiotics for minor viral infections,” Dr Hasan said while adding, “Likewise, without stringent disposal measures, there is a high possibility of people getting exposed to and infected by resistant bacteria.”

AKU and the American Society for Microbiology will also cooperate on a project to train selected microbiologists, to help them learn about international standards to zero-in on resistant bacteria and to properly manage biological wastes.

To fight these health alerts, the experts stressed the need of an effective surveillance system. While talking to the audience, Dr Rana Jawad, Resident Advisor, Field Epidemiology and Laboratory Training Programme, Centers for Disease Control and Prevention, said, “A good surveillance is the need of the hour because in case of a delayed response to an epidemic or an endemic, there is a fair chance that the mortality rate will increase.”

Concluding the symposium, the healthcare experts demanded that the government play a responsible role and take vital steps to implement drug regulations and bio-safety measures and adopt an effective surveillance system for a healthy tomorrow.

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