Influenza-A Virus, not COVID-19, Behind Respiratory Illness Outbreak in Pakistan

As Pakistan faces a surge in respiratory illnesses, the National Institute of Health (NIH) Islamabad has clarified that it is not COVID-19, but a type of influenza virus that is making people sick across the country.

According to the NIH, the H3N2 sub-type of Influenza-A virus is causing severe respiratory illness in adults, while Respiratory Syncytial Virus (RSV) is affecting children. The institute has advised people to take preventive measures, such as coughing etiquette, to avoid contracting the flu virus.

The NIH official told The News that thousands of influenza-like illness (ILI) cases are being reported daily in the country, with the highest number of cases in Sindh, followed by Khyber Pakhtunkhwa, Balochistan and Azad Jammu and Kashmir. Punjab, the largest province of Pakistan, does not share its data with the NIH, so the exact burden of the disease in the province is unknown.

The official said that the COVID-19 positivity rate remained less than 1% during the last week, when only 16 cases were detected across Pakistan after 3,609 tests conducted. He said that most people were neither getting tested for COVID-19 nor the influenza-like illness.

The NIH data showed that a distinct peak of ILI and SARI (severe acute respiratory infection) activity was observed in February, while the influenza virus positivity peaked in December. Out of 311 enrolled patients, 284 (91.3%) were ILI and 27 (8.7%) were SARI cases. Out of 50 influenza virus positive cases, 15 were seasonal H3N2, 14 were H1N1pdm09 and 21 were untyped.

The majority of influenza virus positive cases (98%) presented with current or history of fever, 88% reported cough and 82% reported sore throat. The most common comorbidities in influenza virus positive cases were hepatitis C (4%), obesity (4%) and tuberculosis (6%). The highest incidence of patients reporting to the hospital was seen three days post symptoms onset (66/311) with 14 of these (14/66) positive for influenza virus.

Dr Faisal Sultan, a renowned infectious diseases expert, said that influenza was being diagnosed more due to the availability of PCR at many centres. He said that influenza sometimes causes prolonged fatigue and complications, especially in the elderly or those with other heart or lung conditions.

Dr Raeef Ahmed, a pulmonologist in Karachi, said that influenza A was the most common cause of respiratory illness in the city, sometimes requiring hospitalisation of the elderly with comorbidities. He urged people not to use antibiotics for the treatment of flu, saying that they had found good results of an antiviral medicine Tammy Flu among hospitalised adults. He also said that the influenza vaccine was not available in the market and it was too late to get vaccinated against the flu.

Dr Rana Muhammad Safdar, a renowned epidemiologist, said that poor air quality and smog in Punjab, the federal capital, Khyber Pakhtunkhwa and other areas added to the chances of respiratory illnesses. He advised people to gargle with lukewarm salt water before going to bed to prevent chances of throat infection. He also suggested the same precautions that were used during the COVID-19 pandemic to prevent the spread of the flu virus.

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