Twindemic - An emerging concern in Pakistan


  • Sareema Eman Akhtar Fourth Year MBBS Student, Ziauddin Medical College, Karachi, Pakistan
  • Saad Shakil Fourth Year MBBS Student, Ziauddin Medical College, Karachi, Pakistan
  • Azhar Chachar Fourth Year MBBS Student, Ziauddin Medical College, Karachi, Pakistan



Dear Madam,

As winter approaches, people succumb to a myriad of winter illnesses. Seasonal Influenza (Flu) is predominantly prevalent in the USA and Pakistan. CDC reported 20,000 deaths and 380,000 hospitalizations from flu in 2019 till 2020(1). According to Dr Ebell, we are likely less immune, since we are not exposed to flu for twenty months or even more. There is uncertainty regarding flu strains since it can undergo antigenic shifts and antigenic drift that can cause the evolution of new strains (2). Therefore, CDC estimates that approximately seven hundred thousand people would   get hospitalized in the upcoming flu-season (3).

Flu season paired with covid-19 classically presents as “Twindemic”. Although influenza (Flu) and Covid share similar clinical symptoms, both can have severe, mild or moderate effects, mode of transmission and preventive strategies, but they still differ in their treatment modalities and vaccines. Therefore, during the covid era it has become challenging to report influenza cases as both diseases present with similar symptoms making clinical diagnosis difficult. However, some studies suggest that preventive measures used for Covid were also effective against the prevention of flu. Hence, the number of flu cases were reported to be lower than expected for the year 2020-2021. People infected with Covid and Influenza at the same time, are more prone to develop severe illness. To keep the pressure off healthcare systems, vaccination programmes are imperative. CDC has issued new guidelines for this potential twindemic this winter, stating that flu vaccines must protect against all 4 influenza virus strains that were noy t the recommendation in prior years. However, in Pakistan Flu shots are not prioritized. Even though CDC recommends a flu shot annually, there is no national influenza vaccination policy in Pakistan. Low levels of vaccination are due to little knowledge regarding the importance of influenza prevention, misinformation about its side effects and lack of public awareness (4), due to which the death toll of influenza was reported to be 42.03 per 100,000 of population as per 2018 data (5).

Despite the serious health and economic consequences faced due to influenza, vaccination rates remain low. Pakistan Government must play a pivotal role to include influenza vaccination in its EPI schedule in order to make it available for the citizens at low costs. The risk of co-infection is estimated to be higher as the season changes.


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How to Cite

Akhtar, S. E., Saad Shakil, & Azhar Chachar. (2022). Twindemic - An emerging concern in Pakistan. Journal of the Pakistan Medical Association.



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