PESHAWAR: The Khyber Pakhtunkhwa health department has increased West Nile virus surveillance after the death of a woman from the mosquito-borne disease in a Peshawar village.

The 80-year-old was the first case of West Nile virus in the province.

The death from the infection prompted doctors to call for the establishment of isolation units at medical teaching institutions.

MTI doctors raised questions about the health department’s contact tracing efforts, which, they insisted, didn’t meet expectations.

MTI doctors raised questions about the health department’s contact tracing efforts, which, they insisted, didn’t meet expectations.

Medics call for isolation units at MTIs

They told Dawn that “adequate” steps weren’t taken to collect samples from close contacts of the woman, who was killed by West Nile virus, to prevent and control the spread of the infection.

The doctors said the health department’s representatives visited the affected area but their “efforts were haphazard and incomplete” and they failed to collect blood samples for the virus testing.

“If a single case tests positive for a virus, the area may have 250 suspected and asymptomatic cases that need to be thoroughly investigated,” a senior physician at an MTI told Dawn.

He said none of Peshawar’s MTIs had isolation wards for admitting such patients to prevent the spread of infection.

The doctor said the absence of dedicated facilities at MTIs to admit and care for such patients greatly increased the risk of infection spread.

He added that patients of highly infectious diseases, including XDR Salmonella and Congo Crimean hemorrhagic fever, were kept in general wards or isolated in a room alongside another patient.

“This issue was brought to the attention of hospital administrations and board of governors on multiple occasions but concrete actions are elusive,” he said.

Last month, the health department sent five samples from the people suspected of suffering from Nipha virus to the Public Health Reference Laboratory at the Khyber Medical University for testing.

The lab dispatched specimens to the National Institute of Health in Islamabad, which issued test results on October 23, according to the doctors.

The NIH said all five people tested negative for Nipha virus but one of them, a woman aged 80, was diagnosed with West Nile virus. She died later.

The doctors said all those five people were hospitalised with complaints of vomiting, fever, headache, body pain and fatigue but their condition did not improve with standard medication prompting further testing, which revealed the presence of West Nile virus in an 80-year-old woman.

Experts said West Nile virus was primarily transmitted by female Culex mosquitoes and followed a transmission cycle involving mosquitoes, birds, and animals like horses and donkeys. They added that on rare occasions, humans got infected through mosquito bites.

The experts said in Pakistan, cases of West Nile virus had been documented since 1982.

They said a study conducted on animals revealed an 81.5 per cent sero-prevalence of the virus among horses and donkeys in Punjab and 49.6 pc in equines in Khyber Pakhtunkhwa.

The experts added that the situation had raised concerns in light of the existing burden of mosquito-borne diseases like dengue hemorrhagic fever and malaria in Peshawar.

They advocated thorough contact tracing in such cases to prevent spread of the disease.

The experts said currently, no vaccine or medications was available for West Nile virus, so the cornerstone of managing the disease was through supportive care and preventive measures. They said one of the most crucial elements of prevention was the establishment of isolation units and comprehensive contact tracing.

The experts recommended the use of mosquito repellents, long-sleeved shirts and mosquito nets and elimination of mosquito breeding sites to prevent infection, especially in areas where the virus was endemic.

HMC MD Prof Shehzad Akbar Khan told Dawn they had got isolation side rooms in almost every ward. “At times, we use private rooms as isolation wards,” he said.

Health officials said they had done area’s surveillance but didn’t find anyone with symptoms. We have started collaboration with MTIs to respond to the case, they said.

Published in Dawn, November 10th, 2023