A new study published in the journal PLOS ONE has found that Pakistan's actual dengue burden rose by more than 3,000 per cent between 2012 and 2022, with estimated infections climbing from approximately 100,000 cases to nearly 3.28 million cases over the decade. The research, led by Aga Khan University, underscores a deepening public health crisis that official surveillance figures have consistently failed to capture.

Scale of the Surge

Using statistical modelling and laboratory data, researchers estimated that dengue infections have expanded rapidly across Pakistan in the past ten years. The sharpest rise was recorded among adults aged between 15 and 49 years — a working-age demographic whose illness carries significant economic consequences beyond immediate healthcare costs.

The findings also challenge the long-held assumption that dengue is a seasonal, post-monsoon health concern. Lead author Dr. Zarmeen Nasim said dengue transmission in Pakistan has evolved into a year-round threat rather than a short-lived seasonal outbreak.

Sindh and Karachi Most Affected

The study identified Sindh as the province bearing the heaviest disease load, accounting for an estimated 2.63 million dengue cases in 2022 alone. Within the province, Karachi East recorded the highest district-level incidence, highlighting the disproportionate risk faced by densely populated urban centres where vector control is especially challenging.

Why Infections Are Rising

Researchers attributed the explosive growth in dengue cases to a convergence of structural and environmental factors: rapid urbanisation, inadequate drainage infrastructure, stagnant water accumulation, and the impact of severe flooding events — all of which create ideal breeding conditions for dengue-carrying Aedes mosquitoes. Notably, Pakistan experienced catastrophic floods in 2022, which may have further amplified transmission in the latter part of the study period.

Surveillance Gaps and Policy Gaps

A central concern raised by the study is that routine disease reporting captures only a fraction of actual infections, meaning public health interventions are being calibrated against a significant undercount. The researchers called for a comprehensive overhaul of Pakistan's disease monitoring systems, alongside improvements in municipal sanitation and a systematic expansion of diagnostic capacity nationwide. Stronger surveillance and prevention measures, the study concluded, would be critical to managing recurring dengue outbreaks and reducing the burden of future waves.

The findings add to a growing body of evidence suggesting that dengue's true footprint across South Asia is far larger than official figures reflect — a pattern seen in neighbouring India and Bangladesh as well, where modelling studies have similarly revealed severe underreporting.