Numerous emerging and reemerging infectious microorganisms can pose a serious threat to public health and food security. Pakistan needs to identify these threats, taking into consideration local, regional, and global health security issues. Irrespective of region, country, and race, these infections are serious threats.

1. AliTalha , MuhammadAli,
FaouziaTanveer, Muhammad Ovais,
Muhammad Idrees, Zabta Khan
Shinwari, and James E. Hollenbeck
Research PaperVolume 15
Faisal Hussain
16103
BS Bioinformatics 8th (E)

2. Contents List
• Introduction
• Geography and Demography
• Pakistan in the 21st Century
• Emerging and Reemerging Infectious Diseases
• DengueVirus
• PolioVirus
• HIV-AIDS
• Hepatitis CVirus
• Social issues
• Religious Misconceptions
• Terrorism
• Conclusions
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3. Introduction
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• Numerous emerging and reemerging infectious microorganisms can
pose a serious threat to public health and food security.
• Pakistan needs to identify these threats, taking into consideration local,
regional, and global health security issues. Irrespective of region,
country, and race, these infections are serious threats.
• Emerging infectious diseases (EIDs) are defined as ‘‘infections that have
newly appeared in a population or have existed previously but are
rapidly increasing in incidence or geographic range.’’ Emerging
infectious diseases are a burden on the public health and national
economy and can affect ecological, environmental, and socioeconomic
factors of nations.

4. Geography and Demography
• Pakistan is a large country (about 800,000 km2 ) with a population of
approximately 184,350,000 people, making it the fifth most populous
country in the world according to the World Health Organization
(WHO).
• It is composed of 5 provinces, the Federally Administered Tribal Areas
(FATA), and Kashmir. Even though the country has a fairly well-
developed organizational infrastructure, the health indicators are poor
and show high mortality rates for both communicable and non-
communicable diseases (Figure 1).
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5. Figure 1. Iceberg Model of the Healthcare Issues
in Pakistan
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6. Pakistan in the 21st Century
• The occurrence of emerging and reemerging infectious diseases (Figure 2) can
be a grim situation for third world nations such as Pakistan. This region has
been hit by several epidemics, which we discuss below.
• According to the WHO, the country is at risk for many outbreaks in the future
because of inadequate primary health care, improper sanitation, overcrowded
cities, an insufficient number of medical practitioners and insufficient
medications, contaminated water, lack of awareness among the public about
hygienic conditions,5 meager attention by the government, a large number of
refugees and internally displaced people, religious misconceptions, and
resource limitations.
• Over the years, Pakistan has also suffered from deadly calamities like
earthquakes and floods. Beyond these issues, the country is in a state of war
against internal and external insurgents over the past decade, causing a major
obstacle to primary health care as a result of the diversion of funds to national
security and reaching out to needy people in the affected areas.
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7. Figure 2. Intensity of Different Outbreaks that
Occurred in Pakistan
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8. Continue…
• Pakistan as a developing country faces many challenges because of
limited resources and financial constraints. According to recent data,
Pakistan spends 4.7% of its total budget on health care, which is not
enough for a populous country like Pakistan (Figure 3a and 3b).
• There are estimated to be 2 primary healthcare units per 10,000 people
in the country. The maternal mortality ratio is 170 out of 100,000
people.
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9. Figure 3. Current Situation in Pakistan and
Recommendations for the Future.
• (A) comparison of healthcare expenditure in Pakistan and some other countries.
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10. Figure 3. Current Situation in Pakistan and
Recommendations for the Future.
• (B) recommendations to improve health care in Pakistan
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11. Emerging and Reemerging Infectious Diseases
DengueVirus
• Dengue virus (DENV) is the cause of dengue fever. It is a mosquito-borne
single positive-stranded RNA virus . It is classified into 4 serotypes: DEN-1,
DEN-2, DEN-3, and DEN-4.
• Dengue virus, which is now characterized as an emerging infection, affects
from 50 million to 100 million people globally, with an estimated 24,000
deaths per year. Dengue virus first appeared during World War II and was
reported to have expanded in Asia after the 1980s.
• Dengue fever may be characterized as classical dengue fever, dengue
hemorrhagic fever (DHF), or dengue shock syndrome (DSS).
• Pakistan has had a history of recurrent dengue fever outbreaks since the
1980s. However, it was first documented in 1994 and considered endemic to
Pakistan and other neighboring countries.
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12. PolioVirus
• Polio is a crippling and potentially deadly infectious disease. It is caused by
the poliovirus. The virus spreads from person to person and can invade an
infected person's brain and spinal cord, causing paralysis (in paralysis person
can't move parts of the body).
• Although polio virus has been eradicated from the rest of the world, the
disease continues to be reported in Pakistan, Nigeria, and Afghanistan.
• Pakistan is still struggling to eradicate polio infections due in part to political
instability and to some social and religious misconceptions. Until 2005, the
incidences of polio infection were declining, and the vaccination campaigns
were quite effective.
• Polio cases were reported in Pakistan
• In 2009 -- 89 cases
• In2010-11 -- 144-198 cases
• In 2014 – 306 cases
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13. HIV-AIDS
• Human immunodeficiency virus (HIV, a lentivirus from the Retroviridae family
of viruses) is the causative agent for acquired immune deficiency syndrome
(AIDS), which attacks the immune cells of the infected patient, resulting in a
decline in CD4T cells.
• It is estimated that <0.1% of the Pakistani population has been reported to be
infected with HIV.
• Ghani and colleagues screened 626,413 blood donors from 1998 to 2013 from
northern Pakistan for anti-HIV antibodies; they reported that 0.01% of the
individuals were reactive for HIV antigens. This is also true of blood donors
from Karachi, a major city in the south of the country.
• Awareness programs and stringent surveillance targeting high-risk groups will
be helpful in controlling infection in the future.
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14. Hepatitis CVirus
• According to WHO, about 130 to 150 million people are affected by hepatitis C
virus infection. A significant number of those people develop chronic liver
disease, and an estimated 500,000 die each year globally.
• Hepatitis C virus (HCV) has wide genetic diversity and variations from region
to region based on prevalence of its different genotypes. Globally, genotypes
1 and 3 are most common.
• Hepatitis viral infections are highly endemic in Pakistan, with hepatitis B and C
being a major disease burden with maximum mortality.
• Prevalence of HCV is around 5%, with an estimated 10 million infected
individuals in Pakistan.30 Six genotypes have been identified, with genotype 3
(74%) as the most prevalent.
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15. Social issues
Religious Misconceptions
• About 97% of the population in Pakistan is Muslim, and the impact of religion
is persistent in many aspects of life.
• Polio cases are continuously emerging from different regions in Pakistan.
About 72 new cases were reported in 2015, ahead of Nigeria (50 cases) and
Afghanistan (9 cases).
• Family planning in Pakistan is a highly debated topic because of its religious
implications Pakistan is among the 115 countries globally that accept that
public health care is a right, yet there is huge discrimination between genders,
and especially women who live in rural areas fall victim to religious extremism.
• One study reveals that in Pakistan girls are at a higher risk of death (68%)
compared to boys (57%), indicating a clear bias in the accessibility of social
determinants of health.
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16. Terrorism
• Underfunded and ill-equipped healthcare facilities due to the ongoing war and
infrastructure collapse due to terrorist activities represent the biggest
obstacles to health care for the people of Pakistan.
• No emergency medical services (EMS) exist in Pakistan, and initial help to
victims is commonly provided by untrained but well-meaning people at the
scene.
• Attempts to eradicate viral diseases like polio and measles have been
prevented by attacks by militants since 2012.
• In the past few years, a considerable decrease in terrorist activities has been
reported, and the situation seems to be improving, but it still requires
enormous effort to attain harmony.
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17. Conclusions
• The failure to achieve a good healthcare system has resulted in Pakistan being a
reservoir for infectious diseases, like polio, which have elsewhere been wiped from
the face of the earth.
• Besides the endemic entities, there is a global threat of Ebola virus that demands
serious and dedicated efforts to be undertaken at federal and provincial levels, with
effective participation from civil society and religious scholars.
• At present, Pakistan may not have the capacity to deal with these issues by itself, so
efforts are required by the international community to reduce the existing threat of
emerging infectious diseases.
• The emergency response teams should be properly trained and equipped to respond
to any event. Biosecurity issues must be taken care of. Poor and slow response to
natural disasters like floods and earthquakes should be improved.
• A dedicated, well-planned, integrated effort at all levels of society is needed to cope
with the menace of infectious diseases.
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