Modelling the impact of climate change on dengue outbreaks and future spatiotemporal shift in Pakistan.

Climate change has a significant impact on the intensity and spread of dengue outbreaks. The objective of this study is to assess the number of dengue transmission suitable days (DTSD) in Pakistan for the baseline (1976-2005) and future (2006-2035, 2041-2070, and 2071-2099) periods under Representative Concentration Pathway (RCP4.5 and RCP8.5) scenarios. Moreover, potential spatiotemporal shift and future hotspots of DTSD due to climate change were also identified. The analysis is based on fourteen CMIP5 models that have been downscaled and bias-corrected with quantile delta mapping technique, which addresses data stationarity constraints while preserving future climate signal. The results show a higher DTSD during the monsoon season in the baseline in the study area except for Sindh (SN) and South Punjab (SP). In future periods, there is a temporal shift (extension) towards pre- and post-monsoon. During the baseline period, the top ten hotspot cities with a higher frequency of DTSD are Karachi, Hyderabad, Sialkot, Jhelum, Lahore, Islamabad, Balakot, Peshawar, Kohat, and Faisalabad. However, as a result of climate change, there is an elevation-dependent shift in DTSD to high-altitude cities, e.g. in the 2020s, Kotli, Muzaffarabad, and Drosh; in the 2050s, Garhi Dopatta, Quetta, and Zhob; and in the 2080s, Chitral and Bunji. Karachi, Islamabad, and Balakot will remain highly vulnerable to dengue outbreaks for all the future periods of the twenty-first century. Our findings also indicate that DTSD would spread across Pakistan, particularly in areas where we have never seen dengue infections previously. The good news is that the DTSD in current hotspot cities is projected to decrease in the future due to climate change. There is also a temporal shift in the region during the post- and pre-monsoon season, which provides suitable breeding conditions for dengue mosquitos due to freshwater; therefore, local authorities need to take adaption and mitigation actions.

Assessment of soil-gas radon concentration over lithologies: a case study from district Karak, Khyber Pakhtunkhwa, Pakistan.

The current study is aimed to determine the variation of soil-gas radon concentrations over different rock formations representing diverse lithologies in the district of Karak, Khyber Pakhtunkhwa, Pakistan. The stratigraphic units were grouped on the basis of lithological contents into four categories, i.e., limestone, evaporites, claystone/mudstone, and sandstone. The highest average soil-gas 222Rn concentration (544 Bq/L) was found in the uranium-bearing Dhok Pathan Formation of the Pliocene age, while the lowest radon levels (0.15 Bq/L) were observed in the salt-bearing strata of Bahadurkhel Salt of Eocene age showing the non-uraniferous nature of the salt. High radon potential associated with the Dhok Pathan Formation is likely to be related to the high degree of uranium mineralization which is contributing to the elevated soil-gas radon levels. The study revealed that the soil-gas radon concentration in all lithologies is varying in the order of RnSandstone > RnLimestone > RnClaystone/Mudstone > RnEvaporites with the highest radon levels in the sandstone unit of uranium-bearing Dhok Pathan Formation. High fluctuations of soil-gas radon levels observed in this study evidently show that lithology and uranium mineralization have strong control over the 222Rn concentrations.

A comprehensive review on clinical and mechanistic pathophysiological aspects of COVID-19 Malady: How far have we come?

Since its outbreak in 2019, the coronavirus disease (COVID-19) has become a pandemic, affecting more than 52 million people and causing more than 1 million mortalities globally till date. Current research reveals a wide array of disease manifestations and behaviors encompassing multiple organ systems in body and immense systemic inflammation, which have been summarized in this review. Data from a number of scientific reviews, research articles, case series, observational studies, and case reports were retrieved by utilizing online search engines such as Cochrane, PubMed, and Scopus from December 2019 to November 2020. The data for prevalence of signs and symptoms, underlying disease mechanisms and comorbidities were analyzed using SPSS version 25. This review will discuss a wide range of COVID-19 clinical presentations recorded till date, and the current understanding of both the underlying general as well as system specific pathophysiologic, and pathogenetic pathways. These include direct viral penetration into host cells through ACE2 receptors, induction of inflammosomes and immune response through viral proteins, and the initiation of system-wide inflammation and cytokine production. Moreover, peripheral organ damage and underlying comorbid diseases which can lead to short term and long term, reversible and irreversible damage to the body have also been studied. We concluded that underlying comorbidities and their pathological effects on the body contributed immensely and determine the resultant disease severity and mortality of the patients. Presently there is no drug approved for treatment of COVID-19, however multiple vaccines are now in use and research for more is underway.

SARS-CoV-2: big seroprevalence data from Pakistan-is herd immunity at hand?

PURPOSE: Seroprevalence surveys from different countries have reported SARS CoV-2 antibodies below 20% even in the most adversely affected areas and herd immunity cannot be predicted till more than half of the population gets the disease. The purpose of this survey was to estimate the magnitude of community-based spread of the infection, associated immunity, and the future prospects and proximity to a 'herd community'. METHODS: The study was undertaken as a cluster randomized, cross-sectional countrywide survey. This largest community-based seroprevalence data of SARS-CoV-2 were collected between 15th and 31st July, 2020 from seven randomly selected cities belonging to the three most populous provinces of Pakistan. The FDA approved kit of ROCHE was used for detection of SARS-CoV-2 antibodies. RESULTS: Serum samples of 15,390 participants were tested for SARS CoV-2 antibodies with an overall seroprevalence of 42.4%. The seroprevalence ranged from 31.1% to 48.1% in different cities with the highest in Punjab province (44.5%). In univariable analysis, the odds of seropositivity was higher in men compared to women (OR: 1.10, 95% CI: 1.01-1.19, P < 0.05). In multivariable analysis, the risk of being seropositive was lower (OR 0.72, 95% CI: 0.60-0.87, P < 0.01) in younger group (≤ 20 years) than in those aged above 60 years. CONCLUSION: The study concluded that despite a reasonable seroprevalence, the country is yet to reach the base minimum of estimations for herd immunity. The durability of immunity though debated at the moment, has shown an evidenced informed shift towards longer side.

Xeroderma Pigmentosum Associated with Squamous and Basal Cell Carcinoma in Pakistan: A Case Series.

ABSTRACT: Xeroderma pigmentosum (XP) is an autosomal recessive condition characterized by an extreme sensitivity to UV rays from sunlight. It presents clinically with progressive pigmentary abnormalities and an increased incidence of skin and mucous membrane cancers at sun-exposed sites. Parental consanguinity is a significant risk factor. Previously, cases of XP have been reported from various regions of Pakistan including Larkana, Sibbi, Karachi, Lahore, and District Dir in 1993, 2009, and 2010. Genetic studies have been conducted on seven consanguineous families with XP belonging to the Khosa tribe of Baloch ethnicity. In May 2018, XP was reported in four siblings in a family from a small village in Sindh Province, Pakistan. Current surveillance has been carried out in the tribal village of Lundi Khosa, District Kachhi at Baluchistan, Pakistan. The disease has been endemic in the tribe since 1986, although it was brought under control in the last few years. This case report describes five patients (aged 3-12 years) with XP who have developed nonmelanoma skin malignancies.

Assessment of groundwater intrinsic vulnerability using GIS-based DRASTIC method in District Haripur, Khyber Pakhtunkhwa, Pakistan.

The stress on the freshwater resources of the planet earth has led the United Nations to add a goal regarding clean water in sustainable development goals list in order to address the global availability of clean water. The widespread use of fertilizers and industrial effluents caused the groundwater contamination in the Haripur District, Khyber Pakhtunkhwa, Pakistan. To investigate and assess the vulnerability of groundwater to contamination, geographic information system (GIS)-based DRASTIC model has been employed. The DRASTIC index values lie between 88 and 190. The lower the DI value, the lower will be the susceptibility towards pollution and vice versa. The indices were classified into five zones, i.e., low (< 109), medium (110-129), moderate (130-149), high (150-169), and very high vulnerable zones (> 170) on the basis of equal intervals. The low vulnerable zone covers almost 6% of the study area, i.e., 118 km2. Medium vulnerable zone encompasses an area of approximately 23%, i.e., 506 km2. The moderate vulnerable zone is the largest in the district covering almost 965 km2, approximately 45% of the study area. The high and very high vulnerable zone encompasses almost 23% and 3% of the study area which means 506 km2 and 66 km2 respectively. A spatial distribution map was generated for nitrate concentration to validate the DRASTIC indices. The results demonstrate a fair relation between groundwater susceptibility and spatial nitrate distribution. This index map will provide a baseline study for this area to develop the safe zones for groundwater exploitation and controlling the current state of deterioration of environmental norms. The areas of high vulnerability are the firsthand task to improve the current situation of crisis especially in the southern parts such as the Hattar industrial area and its surroundings drained by those effluents. These further need specific tasks to restore and reclaim the polluted ecosystem by using proper technological solutions for disposal of these effluents.

HyPE study: hydroxychloroquine prophylaxis-related adverse events' analysis among healthcare workers during COVID-19 pandemic: a rising public health concern.

BACKGROUND: The rising burden of Coronavirus disease (COVID-19) has led to the mass use of hydroxychloroquine by healthcare workers (HCWs). Adverse event profile of this drug when used as prophylaxis is not well known in the literature. METHODS: A retrospective, cross-sectional study was conducted across the country using semi-structured web-based questionnaire among COVID-19 negative and asymptomatic healthcare workers, taking hydroxychloroquine prophylaxis. Descriptive and multivariate logistic-regression models were applied for analysis. RESULTS: Of the 166 participants, at least one adverse event was experienced by 37.9% participants, gastrointestinal being the most common (30.7%). Risk was higher in participants <40 years age (odd's ratio (OR): 2.44, 95% confidence interval (CI): 1.18-5.05) and after first dose of hydroxychloroquine (51.2%, OR: 2.38, 95%CI: 1.17-4.84). Hydroxychloroquine prophylaxis was initiated without electrocardiography by 80.1% of HCWs. Only 21.6% of those with cardiovascular disease could get prior ECG. CONCLUSIONS: A higher incidence of adverse events was observed when results were compared with studies involving patients on long-term hydroxychloroquine therapy. Younger age and first dose were associated with greater incidence of adverse events though all were self-limiting. Monitoring prior and during prophylaxis was inadequate even among those with cardiovascular disease and risk-factors. However, no serious cardiovascular events were reported.

Brucellosis in Pakistan: a neglected zoonotic disease.

Brucellosis is a zoonotic disease; endemic but neglected in the South Asian countries including Pakistan. It causes economic loss to the livestock sector and leads to systemic infection in humans. Brucellosis was neglected in Pakistan since long. According to the Staged Tool for the Elimination of Brucellosis (STEB), Pakistan carries a grim landscape of the disease with no structured control activities. This article describes the five-year national brucellosis control strategic plan (2018-2023) formulated by the government of Pakistan using the one-health approach for the prevention and control of disease across the country. The plan incorporates components of surveillance, research, diagnostic capacity, awareness and vaccination using a multi-disciplinary approach.

Phentotypic, gentotypic antimicrobial resistance and pathogenicity of Salmonella enterica serovars Typimurium and Enteriditis in poultry and poultry products.

For detection and isolation of Salmonella enterica, 650 meat and tissue samples were processed using Rappaport-Vassiliadis Enrichment broth and Salmonella Chromogenic agar followed by confirmation through specific antisera and polymerase chain reaction (PCR) targeting their Specific Serovar Genomic Regions (SSGRS). Isolates were tested for 15 antibiotics (CRO, AMX, GEN, STR, TET, CHL, CLR, LVX, OFX, GAT, CIP, SXT, AMP, LIN and AZM) according to the disc diffusion method and antimicrobial resistant genes (tet(A), tet(B), tet(C), strA/strB, aadA, aac(3)IV), aadB, sul1, sul2 and sul3, blaCMY-2, blaTEM and blaSHV) using PCR. The overall prevalence of Salmonella enterica was 12%, being higher in markets (15%) as compared to poultry farms (37.2%). The MPN of all positive meat and tissue samples was found 3.6 MPN/gram (0.17-18). A total of 234 isolates were obtained, serovar Typimurium (139) and Enteridits (95) were the most prevalent. Antimicrobial resistance patterns were different in different serovars according to origin of Salmonella isolates. The overall isolates were highly resistant for LIN (93.1%, 218/234) followed by AMX (80%, 187/234), AMP (74.3%, 174/234), TET (64.5%, 151/234) and STR (64.5%, 151/234). Overall, the most common ARG was blaTEM (76%, 178/234), followed by blaSHV (71.7%, 168/234), tet(A) (64%, 151/234) and tet(B) (64%, 150/234), while the least ARG was aadB (7.2%, 17/234). Both Typimurium and Enteridits were tested in the Balb/C mice for pathogenicity. Both Typimurium and Enteridits were found to cause successful colonization, 100% morbidity but Enteriditis were found to cause 33% mortality.

Association between bacterial strain type and host biomarkers in Clostridium perfringens infected goats.

The study project was designed to determine the effects of Clostridium perfringens type D infection on hematological and biochemical parameters in goats. Purposive blood samples were collected from 6 healthy and 12 diseased goats positive for C. perfringens infection. Neither the animals nor their mother were vaccinated against Clostridium perfringens from whom samples were obtained. Study was carried out in two different topographic areas; hilly (district Swat) and plain (district Mardan) of Khyber Pakhtunkhwa, Pakistan but nonsignificant (P > 0.05) statistical difference was recorded between the prevalence of Clostridium perfringens infected goats. Mean erythrocytes count (RBC) and hemoglobin level decreased significantly (P < 0.05) while the white blood cells (WBC) increased significantly (P < 0.05) in diseased animals compared to the healthy animals. However non-significant differences (P > 0.05) were observed in packet cell volume (PCV) and platelets count in healthy and diseased animals. According to biochemical analysis, a significant increase (P < 0.05) in liver enzymes, total bilirubin, serum creatinine, blood urea and glucose was recorded in diseased goats. . The results demonstrated that fluctuation in most of the mean hematological values remained within the normal range however the mean liver enzymes, total bilirubin, serum creatinine, blood urea and glucose levels gone beyond the normal levels which demonstrated severe damages to liver and kidneys.

Trend Of Irrational Medication Among The Students Of Department Of Pharmacy Abbottabad University Of Science And Technology In Common Cold And Flu.

BACKGROUND: Common cold and flu are mostly of viral pathogenesis with symptoms in upper respiratory tract. It is highly contagious and close inter-individual contact in winter season increase the spread spectrum. Mis-interpretation with bacterial cause leads to irrationality in its medication. METHODS: A cross-sectional study was conducted among pharmacy department students in February-March 2016. Data were collected through self-administered questionnaire and expressed as percentage frequency. RESULTS: Total 180 students were provided with questionnaire to fill the desired data. 66 out of them were reported as patients of common cold and flu. Trend of medication after compilation and analyzing data reveal that: 60.60% (n=40/66) students got irrational medication, 4.54% (n=3/66) students presents with other disease, so were declared of complex nature and 9.1% (n=6/66) patients, presented only with symptoms were counseled accordingly to the standard therapy by Health Protection Agency-UK (Management of infection guidance for primary care for consultation and local adaptation, 2013), and Columbia University Medical Center (Guidelines for the empiric use of antibiotics in adult patients - Feb, 2005) and all of them were followed for their entire therapy time. All of the counseled patients recovered successfully. Total 25.76% (n=17/66) other than that of counseled group students also got rational medication. CONCLUSIONS: Use of medicine by students in study was found irrational. National and international awareness programs about such viral disease should be designed and arranged to promote information in the community and limit the irrational medication. It also need an active health regulatory authority in undeveloped and less developed countries specially to limit the availability of prescription drugs without physician advise through availability of qualified person in pharmacies.

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.

Mortality Associated with Priority Diseases in Flood-Affected Areas Using District Health Information System (DHIS2) During September-December 2022: Pakistan Experience.

OBJECTIVES: To quantify the burden of communicable diseases and characterize the most reported infections during public health emergency of floods in Pakistan. METHODS: The study's design is a descriptive trend analysis. The study utilized the disease data reported to District Health Information System (DHIS2) for the 12 most frequently reported priority diseases under the Integrated Disease Surveillance and Response (IDSR) system in Pakistan. RESULTS: In total, there were 1,532,963 suspected cases during August to December 2022 in flood-affected districts (n = 75) across Pakistan; Sindh Province reported the highest number of cases (n = 692,673) from 23 districts, followed by Khyber Pakhtunkhwa (KP) (n = 568,682) from 17 districts, Balochistan (n = 167,215) from 32 districts, and Punjab (n = 104,393) from 3 districts. High positivity was reported for malaria (79,622/201,901; 39.4%), followed by acute diarrhea (non-cholera) (23/62; 37.1%), hepatitis A and E (47/252; 18.7%), and dengue (603/3245; 18.6%). The crude mortality rate was 11.9 per 10 000 population (1824/1,532,963 [deaths/cases]). CONCLUSION: The study identified acute respiratory infection, acute diarrhea, malaria, and skin diseases as the most prevalent diseases. This suggests that preparedness efforts and interventions targeting these diseases should be prioritized in future flood response plans. The study highlights the importance of strengthening the IDSR as a Disease Early Warning System through the implementation of the DHIS2.

Infectious causes of fever of unknown origin in developing countries: An international ID-IRI study.

Background: Fever of unknown origin (FUO) in developing countries is an important dilemma and further research is needed to elucidate the infectious causes of FUO. Methods: A multi-center study for infectious causes of FUO in lower middle-income countries (LMIC) and low-income countries (LIC) was conducted between January 1, 2018 and January 1, 2023. In total, 15 participating centers from seven different countries provided the data, which were collected through the Infectious Diseases-International Research Initiative platform. Only adult patients with confirmed infection as the cause of FUO were included in the study. The severity parameters were quick Sequential Organ Failure Assessment (qSOFA) ≥2, intensive care unit (ICU) admission, vasopressor use, and invasive mechanical ventilation (IMV). Results: A total of 160 patients with infectious FUO were included in the study. Overall, 148 (92.5%) patients had community-acquired infections and 12 (7.5%) had hospital-acquired infections. The most common infectious syndromes were tuberculosis (TB) (n=27, 16.9%), infective endocarditis (n=25, 15.6%), malaria (n=21, 13.1%), brucellosis (n=15, 9.4%), and typhoid fever (n=9, 5.6%). Plasmodium falciparum, Mycobacterium tuberculosis, Brucellae, Staphylococcus aureus, Salmonella typhi, and Rickettsiae were the leading infectious agents in this study. A total of 56 (35.0%) cases had invasive procedures for diagnosis. The mean qSOFA score was 0.76±0.94 {median (interquartile range [IQR]): 0 (0-1)}. ICU admission (n=26, 16.2%), vasopressor use (n=14, 8.8%), and IMV (n=10, 6.3%) were not rare. Overall, 38 (23.8%) patients had at least one of the severity parameters. The mortality rate was 15 (9.4%), and the mortality was attributable to the infection causing FUO in 12 (7.5%) patients. Conclusions: In LMIC and LIC, tuberculosis and cardiac infections were the most severe and the leading infections causing FUO.

Assessment of Infection Prevention and Control (IPC) Implementation and Strategies Used for IPC Preparedness at Facility Level in Underdeveloped Areas of Pakistan.

Background: During outbreaks of infectious diseases like COVID-19, the healthcare-associated infections (HCAIs) pose a burden on public health system. There are very limited data about infection prevention and control (IPC) implementation in the healthcare facilities of Pakistan. The aim of the study was to conduct assessment with the IPC Assessment Framework (IPCAF) tool in healthcare facilities of the least developed areas. Methods: A cross-sectional survey was conducted in 12 tertiary level healthcare facilities (HCF) located in the least developed provinces of Pakistan. The facilities were selected through multistage cluster random methods. A well-structured questionnaire, the "IPCAF tool", was used for data collection. The IPCAF comprises eight sections with a 100 score of each section, thus with a maximum score of 800. The scores from 0 to 800 of the HCFs were divided into four gradual ratings through IPCAF, ie from inadequate to advanced. Results: The median score of all facilities was 405, with a range from inadequate to advanced. One facility (8.3%) fell into the "inadequate" category with a score of 172.5; 5 (41.6%) facilities achieved "basic" category, another 5 (41.6%) being "intermediate", and only one (8.3%) hospital achieved "advanced" status. Region-wise median score of facilities of GB was 307.5, facilities in AJK scored 342.5, and a score of 520 was found for health facilities in KPK. The components of Education and Training, HCAIs Surveillance, and Multimodal Strategies achieved the lowest scores. Conclusion: Most of the facilities have developed an IPC program with key focal persons and IPC committees, but did not have relevant education and training. IPC core capacities are being implemented. Equitable attention is required on all eight components of IPC in all facilities.

Coordination strategies and concept of operations implemented during activation of public health emergency operations center for COVID-19 response in Pakistan.

Public health emergency management systems encountered difficulties in developing countries, especially in Pakistan. The COVID-19 pandemic was extremely challenging for different agencies/departments in Pakistan. Health emergency management depends on a well-established public health emergency operations center that could generate a coordinated response to emergencies. We conducted an assessment of public health emergency response coordination implemented during the COVID-19 at strategic level. This was mix-method qualitative study. Primary data was collected by using a structured questionnaire, and secondary data was collected by desk review. The agencies engaged in pandemic response at the national level in Pakistan were included in the assessment. The overall score of the emergency response coordination system during COVID-19 was 49% for all agencies. We found that agencies faced challenges in leadership, legislation, and financing issues during the pandemic response (44%). None of the agencies had a fully developed framework for joint planning and response system for health emergencies. Roles and responsibilities attached to designated agencies in response were relatively clear (55%) for most of the agencies. Effective public health emergency response is based on multi-departmental coordination, resource mobilization, and clear roles for each agency. Pakistan must proactively address these challenges for pandemic response in future.

Evaluation of the public health empowerment program in the Eastern Mediterranean region.

Background: The Public Health Empowerment Program (PHEP) is a 3-month training program for frontline public health staff to improve surveillance quality and strengthen the early warning system capacities. Studies evaluating the program and its impact on the health systems in the Eastern Mediterranean Region (EMR) are lacking. Therefore, this study aimed to assess the level of PHEP graduates' engagement in field epidemiology activities, assess their perceived skills and capacity to perform these activities and assess the extent to which PHEP helped the graduates to perform field epidemiology activities. Methods: A descriptive evaluation study was conducted based on levels 3 and 4 of Kirkpatrick's model for evaluating training programs to assess the change in graduates' behavior and the direct results of the program. Data were collected using two online surveys targeting PHEP graduates and programs' directors/ technical advisers. Results: A total of 162 PHEP graduates and 8 directors/ technical advisers participated in the study. The majority of PHEP graduates reported that they are often involved in activities such as responding to disease outbreaks effectively (87.7%) and monitoring surveillance data collection (75.3%). High proportions of PHEP graduates rated their skills as good in performing most of field epidemiology activities. The majority of graduates reported that the PHEP helped them much in conducting, reviewing, and monitoring surveillance data collection (92%), responding effectively to public health events and disease outbreaks (91.4%), and communicating information effectively with agency staff and with the local community (85.2%). Conclusion: PHEP appears to be an effective program for improving the public health workforce's skills and practices in epidemiological competencies in the EMR. PHEP strengthened the engagement of the graduates in most field epidemiology activities, especially during COVID-19.

Mapping of infection prevention and control education and training in some countries of the World Health Organization's Eastern Mediterranean Region: current situation and future needs.

BACKGROUND: A strong understanding of infection prevention and control (IPC) procedures and comprehensive training among healthcare workers is essential for effective IPC programs. These elements play a crucial role in breaking the chain of nosocomial infections by preventing the transmission of resistant organisms to patients and staff members. This study mapped the components of IPC education and training across various member states of the World Health Organization (WHO) in the Eastern Mediterranean Region (EMR) at national, academic, and healthcare institutional levels. METHODS: A self-administered structured online questionnaire based on the WHO "Core Component 3" of IPC programs at the national and acute healthcare facility levels (IPC education and training) was given to national IPC focal persons in each of the WHO's EMR countries between February and March 2023. RESULTS: From 14 of the 22 countries,15 IPC persons participated in the survey. Most countries have scattered nonhomogeneous IPC education programs in human health undergraduate majors without considering it a standalone module. Academic institutions are rarely involved, and elaborate and predefined undergraduate IPC education programs provided by universities are present in 21.4% of the countries. In 71.4% of these countries, postgraduate training targeting IPC professionals is provided by national IPC teams, primarily based on national IPC guidelines developed with the aid of the WHO. Generally, healthcare worker training relies heavily on healthcare facilities in 92.9% of the countries, rather than on a national training program. In 42.9% of the countries, practicing IPC physicians are not necessarily specialists of infectious disease or medical microbiologists and IPC nurses are not required to specialize in IPC. However, nonspecialized IPC professionals are expected to undergo training upon employment and before beginning practice. Nongovernmental organizations such as the WHO play a significant role in IPC education and in supporting national IPC authorities in establishing national IPC guidelines, as it is the case in 78.6% of these countries. CONCLUSION: Clear disparities exist in IPC education and training across different countries in the WHO's EMR. Establishing a regional scientific network specializing in IPC would help bridge the existing gaps and standardize this education within individual countries and across countries in the region. This region needs to establish IPC certification standards and standardized education curricula.

First Report of Aedes vittatus in Islamabad, Pakistan.

Aedes vittatus is distributed throughout Asia, Africa, and Europe and can transmit dengue, chikungunya, yellow fever, and Zika viruses. Like other Aedes species, larvae develop in both natural and artificial containers in urban, suburban, and rural areas. In September 2021, an entomological survey was conducted at the National Institute of Health of Pakistan (NIH) and adjacent housing within the NIH colony. All containers with water were examined for Aedes mosquitoes at 150 locations, including residential properties, a plant nursery, junkyards, and recreational parks and playgrounds. A total of 103 larvae, 37 pupae, 5 female and 2 male Ae. vittatus were collected from a fountain. This was the first detection of Ae. vittatus in urban Islamabad. Additional vector surveillance is needed to better understand the geographical distribution, ecology, and behavior of this invasive species and to understand its possible role in the transmission of dengue and chikungunya viruses in Pakistan.