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4 Yuan Z, He C, Yan S, Ke Y, Tang W. Randomized
90 000 Notified dengue cases
controlled clinical trial on the efficacy of
Deaths 81 832
fosfomycin trometamol for uncomplicated
80 000
gonococcal urethritis in men. Clin Microbiol
Infect 2016; 22: 507–12. 70 188
70 000
5 Hauser C, Hirzberger L, Unemo M, Furrer H,
Endimiani A. In vitro activity of fosfomycin
Cases and death counts
60 000
alone and in combination with ceftriaxone
or azithromycin against clinical Neisseria 50 000
gonorrhoeae isolates. Antimicrob Agents
Chemother 2015; 59: 1605–11. 40 000
30 000
18 461
Unprecedented rise 20 000
in dengue outbreaks 10 000
38 56 73 131 2 324 2 2208
8 39 67 67
in Bangladesh 0
January February March April May June July August September
Dengue is a common mosquito- Figure: Dengue notifications and deaths in Bangladesh in 2019
borne infection that affects millions
of people each year. 75% of the Bangladesh, such as diphtheria. 4 *Kamrul Hsan, Md Mahfuz Hossain,
world’s dengue burden is in Asia, However, reliable data supporting the Md Shanjid Sarwar,
particularly in countries such as the importation of dengue via Rohingya Annelies Wilder-Smith, David Gozal
Philippines, Indonesia, and Thailand.1 refugees do not exist. Given the [email protected]
Bangladesh, in south Asia, has lower increasing connectivity of air travel,5 Department of Public Health and Informatics,
dengue seroprevalence than countries it is more plausible that dengue Jahangirnagar University, Savar, Dhaka 1342,
Bangladesh (KH, MMH, MSS); Institute of Allergy
in southeast Asia,2 but the situation outbreaks in Bangladesh are a result of and Clinical Immunology of Bangladesh, Savar,
is rapidly changing. We highlight the dengue importation from southeast Dhaka, Bangladesh (KH); Humanitarian Response
largest dengue outbreak in Bangladesh Asia, which is currently also witnessing Organisation, Dhaka, Bangladesh (KH); Department
for Disease Control, London School of Hygiene &
on record, which is taking place this an unusually elevated dengue pre Tropical Medicine, London, UK (AW-S); Heidelberg
year. valence. Climate change, unplanned Institute of Global Health, Heidelberg, Germany
Bangladesh had sporadic trans rapid urbanisation and construction, (AW-S); and Department of Child Health, and the
Child Health Research Institute, University of
mission of dengue virus from 1964 high population densities, and the Missouri School of Medicine, Columbia, MO,
to 1999, but the first outbreak due struggling health-care system in USA (DG)
to dengue virus type 3 occurred Bangladesh further compound the 1 Wilder-Smith A, Ooi E-E, Horstick O, Wills B.
in 2000, 2 with dengue outbreaks magnitude and severity of dengue Dengue. Lancet 2019; 393: 350–63.
occurring at increasing frequency 2 Sharmin S, Viennet E, Glass K, Harley D.
outbreaks. Additionally, Bangladesh’s The emergence of dengue in Bangladesh:
and magnitude since then, peaking insufficient preparedness, including epidemiology, challenges and future disease
with 10 148 cases in 2018.3 In 2019, inadequate public health infrastructure risk. Trans R Soc Trop Med Hyg 2015;
109: 619–27.
dengue outbreaks surpassed all and suboptimal vector-control pro 3 Akram A. Alarming turn of dengue fever in
previous records, mostly in the capital grammes, further magnifies the impact Dhaka city in 2019. Bangladesh J Infect Dis
2019; 6: 1–2.
city of Dhaka. By August, 2019, a total of dengue virus importation, resulting
4 Rahman MR, Islam K. Massive diphtheria
of 70 188 dengue cases had been in epidemics of escalating severity. outbreak among Rohingya refugees:
officially recorded, with 67 dengue- Consequently, there is an urgent lessons learnt. J Travel Med 2019; 26: tay122.
related deaths. The numbers increased need to improve prevention and 5 Glaesser D, Kester J, Paulose H, Alizadeh A,
Valentin B. Global travel patterns: an overview.
to 81 832 cases with 67 deaths as control strategies in Bangladesh. J Travel Med 2017; 24: 24.
of the last count on Sept 16, 2019 Communities need to be engaged in
(figure). This high frequency of community-based measures to reduce
dengue cases is due to dengue virus mosquito breeding sites. Tools for Dengue infection in
type 3, but all other serotypes are co- early detection of dengue infection
circulating.4 need to be provided to all health-
Pakistan: not an
What are the reasons for this un care facilities, including diagnostic isolated problem
precedented rise in dengue cases? laboratory capability. Finally, clinicians
Bangladesh has had an influx of in Bangladesh need to be trained in Up until October, more than
Rohingya refugees from neighbouring managing severe dengue to reduce 19 000 cases of dengue infection and
Myanmar, which has led to a rise fatality rates. 30 deaths had been reported by the
in many infectious diseases in We declare no competing interests. National Institute of Health, Pakistan,
www.thelancet.com/infection Vol 19 December 2019 1287
Correspondence
in 2019. From 1995 to 2019, there Pakistan has a population of more resources, eradication of this mosquito
were around 147 200 cases of dengue than 216·5 million people, making it is extremely important, particularly
infection and over 800 deaths. 1 the fifth most populous country in the in view of the potential for spread of
Dengue serotype 2 is the most world. The Pakistani urban population other viral infections. Planning and
prevalent circulating serotype in increased from 19·7% (of the total control measures need to be strictly
Pakistan, with few reported cases population) in 1955 to 34·9% in 2019 implemented by authorities to stop
of serotype 3. In 2017, the Pakistani (equating to a 15·2% increase), and further epidemics of infections spread
northern province of Khyber the total population has increased by by Aedes mosquitoes.
Pakhtunkhawa faced an epidemic 176 million since 1955. The density of I declare no competing interests.
of dengue, with 18 856 cases and the population stands at 281 per km².5
Zareen Fatima
multiple deaths, which was attributed With an increasing yearly growth [email protected]
to a different lineage of dengue virus rate of 2·04%, the use of resources
Department of Biological Sciences, International
serotype 2 circulating in Pakistan. This has increased too.4 Pakistan, especially Islamic University, Islamabad 44000, Pakistan
lineage entered Pakistan from China the metropolitan cities of Karachi and 1 International Federation of Red Cross and
around 2016 and spread in 2017.2 Lahore, has a humid and hot climate. Red Crescent Societies. Emergency plan of
Vectors of dengue virus are mos A drastic increase in population has action (EPoA); Pakistan: dengue outbreak.
http://adore.ifrc.org/Download.
quitoes in the Aedes genus, which caused unplanned urbanisation, aspx?FileId=170525. Oct 11, 2019
are capable of transmitting other with a resulting increase of sanitary (accessed Oct 18, 2019).
2 Ali A, Fatima Z, Wahid B, Rafique S, Idrees M.
viruses, such as chikungunya, Zika, problems. Stagnant water, open or Cosmopolitan A1 lineage of dengue virus
and yellow fever. From 2016 to 2018, blocked sewers, and heaps of garbage serotype 2 is circulating in Pakistan: a study
chikungunya virus infections were are found everywhere. Our people are from 2017 dengue viral outbreak. J Med Virol
2019; 91: 1909–17.
reported in 776 patients in Pakistan.3 prone to use water excessively (eg, for 3 Badar N, Salman M, Ansari J, Ikram A, Qazi J,
Vector populations are increasing washing vehicles, car porches, grounds, Alam MM. Epidemiological trend of
chikungunya outbreak in Pakistan: 2016–2018.
in areas around the world, which as roads, verandas, and gardens), which PLoS Negl Trop Dis 2019; 13: e0007118.
argued by Lydia H V Franklinos and causes water to stand still for many 4 Franklinos LHV, Jones KE, Redding DW,
colleagues,4 is not only a result of days. All of these factors add to Abubakar I. The effect of global change on
mosquito-borne disease. Lancet Infect Dis
climate change. Other global change increased rates of breeding of Aedes 2019; 19: e302–12.
factors—including the growing mosquitoes. Previously a dweller of 5 UN Department of Economics and Social
population and increasing agriculture, greenery, these mosquitoes became Affairs, Population Division. World Population
2019. https://population.un.org/wpp/
deforestation, and urbanisation— domesticated through extensive travel Publications/Files/WPP2019-Wallchart.pdf
equally and substantially contribute to and trade in different areas of the (accessed Oct 18, 2019).
6 Fatima Z, Afzal S, Idrees M, et al. Change in
the spread of mosquitoes. Considering world. This adapted behaviour of Aedes demographic pattern of dengue virus
this argument, Pakistan has all the mosquitoes has also been observed in infection: evidence from 2011 dengue
elements required for a rise in the Pakistan.6 outbreak in Punjab, Pakistan. Public Health
2013; 127: 875–77.
number of infections transmitted by With exponential increase in
mosquitoes. population numbers and use of
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