KARACHI: There is only one laboratory in the entire province to deal with an influenza outbreak and that too is not functioning to a level that it could cater to an emergency situation, it emerged on Sunday.

Sources said that no process had yet been started to make the laboratory robust, though the city, and the country as a whole, faced a potential swine flu outbreak threat from India, where an influenza virus (believed to have mutated) has claimed around 1,500 lives so far.

A visit to the influenza laboratory manned by five people at the Civil Hospital Karachi (CHK) showed that though it has some modern machines for microbiological examination, the testing process had remained suspended due to repairs. The relevant staff could not provide detailed information from its records about the tests done over the past 15 to 20 days.

Know more: Experts warn of swine flu outbreak

“There were some seepage problems which have now been fixed. We have the facility to diagnose swine flu but samples are sent to the National Institute of Health (NIH) in Islamabad, if there is some confusion,” said Dr Rubina Shahid Qureshi, who has recently taken charge of the laboratory, adding that the hospital had received an alert on swine flu from the federal health ministry.

Though she insisted that the facility was being efficiently run, the laboratory appeared to be recently renovated and had the atmosphere of a non-active facility. Sources told Dawn that the laboratory often ran out of diagnostic kits and so samples were sent to the NIH for diagnosis.

According to the staff, 249 tests were conducted at the laboratory last year, all of which were of normal influenza while 260 tests were done between 2011 and 2013. Most test samples were taken from patients in Karachi, particularly those who were hospitalised at the CHK.

The laboratory requirements, they said, were still met by the NIH, though the federal government had asked the provinces to start the process of financing influenza laboratories, also established in Lahore, Peshawar, Multan, Islamabad, Gilgit-Baltistan, Muzaffarabad and Quetta.

The laboratory was set up with funding support from the US Centres for Disease Control and Prevention in 2009 following an outbreak of swine flu (H1N1 influenza pandemic) that, according to a 2012 study published in the medical journal, The Lancet Infectious Diseases, claimed between 151,700 and 574,400 lives worldwide. It was estimated that more than half of all 2009 H1N1-related deaths had occurred in African and Southeast Asian regions.

“One laboratory is not sufficient to meet the need of an entire province. Under the International Health Regulations to which Pakistan is a signatory, there should be at least one microbiological laboratory in every district to do different kinds of tests,” said Dr Shakeel Mullick who headed the laboratory before it was handed over to Dr Qureshi.

The health alert released from the federal health ministry on swine flu was ‘of low virulence’, he added.

Officials at the CHK believe that if an outbreak of swine flu occurs, the federal government needs to come forward and support the provinces.

In 2009, 1,242 suspected cases of swine flu were reported from Pakistan. Around 262 were confirmed by laboratories while 29 people died.

Apathy of health officials

Contacts with health officials showed that there is no alarm at the provincial and federal level on the swine flu threat. In fact, officials at the federal level demonstrated an acute lack of seriousness when approached to speak on the subject.

The NIH officials initially refused to share any information but later insisted that there was no ‘hyper-activity’ or reason for public concern when asked whether any suspected or confirmed cases of swine flu had been detected in Pakistan.

“You should talk to Mr Mazhar who is the spokesperson of the health ministry,” said Dr Farnaz Malik, the acting NIH executive director.

Mr Mazhar Nisar Sheikh didn’t reply to repeated calls and text messages the whole day. After a prolonged wait of many hours, a man who identified himself as the public relations officer of Ms Saira Afzal Tarar (heading the Ministry of National Health Services Regulation and Coordination) called this reporter and said: “A case of swine flu from Multan has been confirmed while five to six are suspected cases.”

He could neither give details of the confirmed case nor knew anything more about the suspected ones.

Upon contact, Executive District Officer health Dr Zafar Ejaz expressed ignorance about the CHK influenza laboratory and said: “There is no laboratory to diagnose swine flu in Karachi. This matter needs to be highlighted in the media.”

According to Dr Altaf Ahmed, Director Laboratory Services and Consultant Microbiologist at the Indus Hospital, there was a need to remain alert and hospital authorities must carry out random sampling and testing to detect suspected cases.

“We need to be on watch. The illness presents itself with flu-like symptoms and is likely to attack people with compromised immunity levels such as people suffering from chronic infections, children and pregnant women. Since we have a weak surveillance system, we don’t know whether the specific H1N1 virus killing people in India has already reached Pakistan,” he added.

Deaths from the 2009 swine flu, he said, were grossly under-estimated in the country as it didn’t have a proper surveillance and diagnosis system for the infection. “If an outbreak occurs in Pakistan, it would be a bigger disaster than the 2009 outbreak because the public health system has weakened after devolution and there is lack of coordination between provinces and the federal government,” he pointed out.

Published in Dawn, March 16th, 2015

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