Post‐flood infectious disease prevention and control: Current scenario in Pakistan

Currently, Pakistan is experiencing monsoon rainfall that is three times greater than usual, according to the World Weather Attribution (WWA, 2022). As a result, unmanageable urban–rural flash floods, as well as landslides have occurred across the country. A complete picture of the scope of the disaster is difficult to obtain because many impacted locations remain inaccessible due to waterlogged and damaged transportation networks. Since mid-June, heavy monsoon rain and floods have impacted 33 million people in Pakistan, leading to nearly 1500 deaths, and the destruction of at least 1.7 million homes, 269 bridges, 6700 km of road, 18,590 schools and 1460 health facilities; approximately 750 thousand livestock have perished, and about 18,000 km2 agricultural land has been damaged (WWA, 2022). Humanitarian partners are assisting the government-led response in impacted regions, diverting current resources to meet the most pressing needs while striving to scale up the response even further (World Meteorological Organisation, 2022). The flood-affected areas serve as perfect breeding grounds for infectious disease transmission. Poor sanitary standards in rescue camps set-up for the people displaced by flooding, also contribute to this. Floodwater stagnation serves as a favourable breeding habitat for potential germs causing diarrhoea and other waterborne diseases. Diarrhoea, cholera and scabies cases have already been recorded and a cholera epidemic has been verified in district Swat, Pakistan, while other diseases including malaria, dengue, polio and hepatitis are on verge of emerging in these areas (Baqir et al., 2012). In Pakistan, the epidemics of current illness such acute watery diarrhoea, polio, dengue fever, COVID-19 and malaria are getting worse, especially in camps and places where water and sanitation infrastructure has been devastated (World Health Organization, 2022). A total of 149,551 cases of diarrheal infections, 142,739 case of skin infections, 132,485 cases of acute respiratory illness and 49,420 probable malaria cases were recently reported in flood-affected areas of Pakistan (Ochani et al., 2022). The most common health consequences of post-floods are gastrointestinal, skin, eye and respiratory infections. They are major causes of sickness and mortality in persons who have been displaced by natural disasters. Crowding and a lack of access to healthcare services increase the risk of mortality from these illnesses. Floods have a detrimental impact on supply systems and water sources, as well as waste disposal and sewage, which increases the risk of spread of disease. Floods can also accelerate the spread of viral illnesses, particularly water and air-borne pathogens (Yavarian et al., 2019). After floods, mosquito-borne illnesses such as dengue fever might become more prevalent, particularly in endemic areas. Standing water from river overflows might serve as mosquito breeding grounds. As a result, vector-borne illnesses have long-term consequences for public health. During heavy rains and flooding, rodent-borne illnesses also become more prevalent (Esfandiari et al., 2017). Therefore, post-flood public health initiatives must be taken in order to reduce the risk of spread of infections. A fast risk assessment must be carried out within the first week of the inundation. Data should be collected from flooded regions, individuals and major disease hazards to identify appropriate responses. The initial public health response to floods includes sanitation, hygiene, nutrition, water and shelter. There must be a plan in place to reduce morbidity and death associated with flood disasters. Authorities should take infection-control measures based on local weather conditions, extent of flooding and the ease of transmission of infection. The people affected by floods must be made aware of the precautionary measures for the control of infectious diseases. They should wash their hand before and after the meal. They need to use disinfected or boiled water for drinking. They should not use food contaminated with flood water and in case of fever, early medication must be used. They should also be taught how to prevent the accumulation of water near their homes and protect themselves from mosquito bites. In case of road side injuries, they need to have tetanus vaccination. Furthermore, it is important to establish the health relief response in flood rescue and relief camps and to adopt follow up health procedures. The camp authorities also must ensure the provision of chlorinated drinking water, safe food, and vaccination and implementation of control programmes against vector-borne disease. It is also important to provide early diagnostic and medication facilities for infectious diseases in camps. In order to limit and control the risks of future floods, flood control measures like construction of dams, public education, risk management and institutional measures should be initiated alongside suitable operational guidelines. A surveillance and reporting programme will assist in detection and prevention of epidemics of infectious disease. In addition, to assist the flood victims and successfully address all the obstacles, the various governments, international organisations and non-governmental groups must work together within a framework of mutual understanding. The authors declare no conflict of interest. The data used from secondary sources were dully cited in the text.