Dengue in Pakistan is far bigger than the official numbers — and it is now a year-round threat

Dengue fever has quietly become one of Pakistan’s biggest health problems — and the real number of infections is far higher than the figures that appear in official reports. A major new study led by Aga Khan University estimates that dengue infections in Pakistan rose from around 100,000 in 2012 to about 3.28 million in 2022, an increase of more than 3,000 per cent in a decade.

The study, published in the peer-reviewed journal PLOS ONE on 2 July 2026, is one of the most detailed assessments of Pakistan’s dengue burden ever carried out. It used laboratory-confirmed cases from three nationwide diagnostic laboratory networks, combined with statistical modelling, to estimate how many people were actually infected — including the many who never appear in official surveillance figures.

The findings were widely reported in Pakistan and abroad on 1 November 2026, just as the country enters the peak of the annual post-monsoon dengue season. The latest weekly surveillance bulletin from the National Institutes of Health (NIH) in Islamabad counted 1,728 suspected dengue cases in a single week — and that figure does not even include Punjab, the country’s largest province, which did not report its numbers.

At a glance

What happened: A study led by Aga Khan University, published in PLOS ONE, estimates that dengue infections in Pakistan grew from about 100,000 in 2012 to around 3.28 million in 2022 — a rise of more than 3,000 per cent. The researchers say routine surveillance captures only a small fraction of the true burden.

Why it matters: Dengue is no longer a short seasonal outbreak in Pakistan. The researchers found evidence that it is now a year-round health risk, driven by climate change, rapid urbanisation and poor sanitation. The disease hits working-age adults hardest, and the province of Sindh carries the heaviest burden.

What happens next: Health authorities are in the middle of the peak transmission season, which usually runs from September to November. The NIH is publishing weekly bulletins, and provincial health departments are running anti-dengue drives — but the study’s authors say Pakistan urgently needs better surveillance, stronger prevention and a long-term plan, including considering a dengue vaccine, which is not currently available in the country.

A decade of growth, hidden in plain sight

The headline number from the study is striking. In 2012, the researchers estimated roughly 100,000 dengue infections across Pakistan. By 2022, that estimate had reached about 3.28 million — more than 30 times higher.

The study looked at laboratory-confirmed dengue cases from January 2012 to December 2022, covering all four provinces, 86 districts and the federal territory. It broke the figures down by five age groups and by sex, giving an unusually complete picture of who is getting infected and where.

The sharpest rise was among adults aged 15 to 49 — the working-age population. In 2022, this group had the highest incidence rate of any age group, at 56 cases per 1,000 people, or about 1.6 million infections in that age group alone. Men were affected more than women, a pattern that held across all age groups.

“Pakistan’s dengue burden may be substantially greater than routine surveillance figures indicate,” the study concluded, calling for “effective public health interventions and enhanced data collection mechanisms”.

Sindh carries the heaviest burden

The burden is not spread evenly across the country. Sindh emerged as the most affected province by a wide margin. In 2022, Sindh had an estimated incidence rate of 45.63 cases per 1,000 people — about 2.63 million infections in that province alone. That is roughly four out of every five estimated dengue infections in the whole country.

Balochistan, by contrast, had the lowest estimated burden, at 0.44 cases per 1,000 people, or about 6,785 infections in 2022. Punjab also showed moderate to high incidence rates, with marked increases over the study period, particularly in upper and central Punjab, including Lahore, Muzaffargarh, Multan and Rahim Yar Khan. Karachi, Ghotki and parts of interior Sindh were identified as high and medium-risk areas.

The researchers linked Sindh’s high burden to its hot, humid climate and its exposure to heavy rains and flooding, which create ideal conditions for mosquitoes to breed. But they stressed that climate is only part of the story. Population growth, urbanisation, poor drainage, inadequate waste disposal and unreliable water supplies all play a role.

The 2026 season: cases rising week by week

The study covers the period up to 2022, but the latest surveillance data shows the problem has not gone away. According to the NIH’s Integrated Disease Surveillance and Response bulletins, suspected dengue cases have risen every week in recent weeks.

In epidemiological week 41 of 2026 — the week ending in late October — Pakistan reported 1,728 suspected dengue cases, up from 1,553 the week before. Khyber Pakhtunkhwa accounted for 1,408 of them, Sindh for 292, Azad Jammu and Kashmir for 23 and Balochistan for five. Punjab did not report, so the national total leaves out the country’s largest province.

The weekly count has nearly quadrupled in five weeks, from 461 in week 37 to 1,728 in week 41. Across those five weeks, the NIH bulletins add up to 5,717 suspected cases — again, without Punjab.

These are suspected cases, not laboratory-confirmed ones. In week 41, public health laboratories in Sindh tested 2,384 dengue samples and found 177 positive — about 7.4 per cent. The NIH bulletin had no laboratory results for Khyber Pakhtunkhwa, Islamabad or Punjab that week, so the high case count in Khyber Pakhtunkhwa is not lab-confirmed in the bulletin.

Khyber Pakhtunkhwa has become a particular focus of concern this season. The province reported 3,671 dengue cases in 2026 up to mid-October, including two deaths in Abbottabad during the week ending 16 October, according to provincial health department figures. Kohat was the worst-affected district, with 2,319 cases, followed by Peshawar with 500. Other affected districts included Bannu, Khyber, Haripur and Abbottabad. The province had 134 active cases at the time of that count.

In contrast, Islamabad reported just 42 cases between 1 January and 16 October, according to the District Health Office. But officials caution that figures from different provinces cover different reporting periods and surveillance systems, and should not be compared directly.

Lahore, which has suffered severe dengue outbreaks in the past, reported 103 positive cases between 1 January and 26 October 2026, with 119 cases across the whole Lahore Division. Field teams have eliminated 264,000 larvae, and 864 cases have been registered against property owners for failing to carry out anti-dengue measures. No deaths have been reported in Lahore this year.

Why dengue keeps growing

Dengue is caused by a virus spread mainly by infected female Aedes mosquitoes, which bite during the day. The disease is endemic in Pakistan, which means it is present in the country all year round, with outbreaks that usually intensify after the monsoon, from September to November.

Rainfall creates temporary pools of water in discarded containers, old tyres, construction sites, rooftops and uncovered water storage vessels. These are ideal breeding grounds for mosquitoes. But rain is not the only factor. Poor drainage, inadequate waste disposal, dense urban settlements and unreliable water supplies also create favourable conditions. In areas where households cannot depend on a continuous water supply, people store water in containers that, left uncovered or uncleaned, become breeding sites.

The PLOS ONE study found recurring post-monsoon peaks in laboratory-confirmed cases between 2012 and 2022, but also a longer-term increase in incidence, particularly in Sindh and Khyber Pakhtunkhwa. The researchers cautioned that dengue should not be viewed only as a seasonal threat, because transmission can persist throughout the year where conditions suit the mosquito.

Climate change, urbanisation and inadequate sanitation are among the factors associated with the growing risk. The World Health Organization says almost half of the world’s population — about four billion people — live in areas where there is a risk of dengue, and the disease is now a growing threat in many parts of the world.

Four types of virus — and why a second infection can be worse

There are four recognised types, or serotypes, of the dengue virus. Infection with one type generally gives long-term protection against that particular type, but not against the others. A person can therefore catch dengue more than once, and a second infection with a different type is linked to a greater risk of severe disease.

Most people recover within a week or two. But a small number develop severe dengue, which can lead to shock, internal bleeding or organ damage. The World Health Organization stresses that early recognition, appropriate clinical management and timely treatment of severe cases can substantially reduce deaths.

Warning signs that need urgent medical attention include severe abdominal pain, persistent vomiting, bleeding from the gums or nose, unusual drowsiness or restlessness, breathing difficulty, and signs of circulation problems such as cold, clammy skin. Anyone with these symptoms should seek medical care immediately.

The NIH’s advice for people with dengue fever is to take paracetamol for fever, drink plenty of fluids, and avoid aspirin and ibuprofen, which can increase the risk of bleeding. This is general public health information, not personal medical advice — anyone who is ill should consult a doctor.

What can be done — at home and by the authorities

Health authorities typically use a combination of mosquito surveillance, removing breeding sites, targeted insecticide spraying and public awareness campaigns. But removing stagnant water matters more than spraying alone, because spraying does not kill mosquito eggs and larvae hiding in containers. Households can reduce the risk by covering stored water, regularly emptying and cleaning containers, clearing blocked drains, disposing of discarded tyres and rubbish, and using mosquito repellents, window screens and protective clothing. Local administrations need to ensure regular waste collection, effective drainage and inspections of construction sites and other places where water collects.

The effectiveness of these measures depends on sustained action rather than short campaigns launched only after cases begin to rise. Surveillance data should be used to identify hotspots and direct resources before transmission accelerates, the researchers and health officials say.

There is also a longer-term question. The PLOS ONE study noted that a dengue vaccine offers a long-term, sustainable way to reduce the growing burden of the disease — but there are currently no dengue vaccines available in Pakistan. The authors suggested that making a vaccine available should be part of the country’s future planning.

Health officials in Khyber Pakhtunkhwa have also pointed to a more basic problem: incomplete reporting. They have attributed the continuing spread in affected areas partly to inconsistent coordination between departments and difficulties obtaining complete patient records from medical teaching institutions. If diagnosed patients are not included in district surveillance records, authorities may underestimate local transmission and struggle to direct resources where they are most needed.

What happens next

Pakistan is now in the most dangerous weeks of the dengue season. October and November are the months when transmission is usually at its highest, and cold nights later in November usually slow the mosquito down — although that is a seasonal pattern, not a guarantee.

For now, the study’s message is clear: the official case counts that appear in the news are only the visible tip of a much larger problem. In 2022, the real number of infections was estimated at 3.28 million. The surveillance system counted only a small fraction of them.

Frequently asked questions

What is dengue fever?
Dengue is a viral illness spread by infected Aedes mosquitoes, which bite mainly during the day. It is common in tropical and subtropical regions, including Pakistan. Many infections cause no symptoms, while others cause fever, headache, muscle and joint pain, and a rash.

How many dengue cases does Pakistan really have?
Official surveillance counts only a fraction of infections. A study led by Aga Khan University and published in PLOS ONE estimated about 3.28 million infections in 2022, compared with roughly 100,000 in 2012. In a single week in late October 2026, the NIH recorded 1,728 suspected cases — and that figure excluded Punjab, which did not report.

Which areas are worst affected?
Sindh had the highest estimated burden in the study, with about 2.63 million infections in 2022. In the 2026 season so far, Khyber Pakhtunkhwa has reported the most cases, with Kohat the worst-affected district. Lahore reported 103 cases between January and 26 October 2026.

Can you get dengue more than once?
Yes. There are four types of dengue virus. Infection with one type gives lasting protection against that type only, so a person can be infected again by a different type. A second infection carries a higher risk of severe illness.

What are the warning signs of severe dengue?
Severe abdominal pain, persistent vomiting, bleeding, unusual drowsiness or restlessness, breathing difficulty and signs of circulation problems need urgent medical attention. Anyone with these symptoms should seek medical care immediately.

How can I reduce the risk at home?
Remove standing water where mosquitoes breed: cover stored water, empty and clean containers regularly, clear blocked drains, dispose of old tyres and rubbish, and use repellents, window screens and protective clothing. Spraying alone is not enough, because it does not kill eggs and larvae in containers.

Conclusion

The 2026 season is already under way, with cases climbing week by week and Khyber Pakhtunkhwa’s Kohat district at the centre of the current outbreak. The tools to fight dengue are well known: clean water storage, removing breeding sites, good surveillance and quick medical care for the seriously ill. What the study shows is that Pakistan needs to use them consistently, all year round — and to start counting the true scale of the problem honestly, so that resources go where the mosquitoes, and the patients, actually are.

Disclaimer: This article is general information only and is not medical advice. It is based on published research and public health guidance. If you or someone you know has symptoms of dengue fever, or any health concern, please consult a qualified doctor or seek care at a health facility. Do not use this article to diagnose or treat any illness.

Sources

• Nasim Z, Reiner RC, Sheikh S, Khan NS, Ali M, Tejani I, et al. (2026) “Incidence of Dengue Fever in Pakistan.” PLOS ONE 21(7): e0352938. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0352938
• WE News English, “A Mosquito Bite, A Mounting Crisis: Pakistan’s Dengue Challenge” (2026). https://wenewsenglish.com/a-mosquito-bite-a-mounting-crisis-pakistans-dengue-challenge/
• Pakera, “Dengue Cases in Pakistan 2026: Weekly Count by Province” (NIH week 41 bulletin, published 28 October 2026). https://pakera.pk/dengue-cases-pakistan-2026-weekly-by-province/
• Daily Kiran, “Dengue Cases in Pakistan Surge Over 3,000% in a Decade, Estimated 3.28 Million Infections in 2022” (1 November 2026). https://dailykiran.com/dengue-cases-in-pakistan-surge-over-3000-in-a-decade-estimated-3-28-million-infections-in-2022/
• The News, “103 dengue cases reported in Lahore” (October 2026). https://www.thenews.pk/print/1445277-103-dengue-cases-reported-in-lahore
• World Health Organization, “Dengue and severe dengue” (fact sheet). https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue