1 Introduction
The 2025 monsoon flood in Pakistan led to catastrophic mortality, mass displacement, and large-scale destruction of water, sanitation, and hygiene (WASH) systems. These floods have triggered a severe health crisis as millions remain in overcrowded shelters that lack basic health facilities and have limited clinical surge. Due to WASH collapse, uncontrolled vector proliferation, shelter crowding, and fragile supply chains, such hydrometeorological extremes predictably escalate into infectious disease emergencies (). It is evident from clearly connecting these occurrences to flood patterns caused by climate change that extreme weather now directly increases the spread of infectious diseases, resulting in a cascading public health calamity. To avert a subsequent calamity, robust vector control, restoration of WASH, proactive testing, and case management that is cognizant of antimicrobial resistance (AMR) are imperative for both Pakistan and global health security. Therefore in addition to the initial devastation caused by the storm, waterborne and foodborne infections are major concerns ().
2 The cascading post-disaster infectious disease crisis
Cholera and enteric fever require immediate action as they severely constrain treatment capacity. Leptospirosis and Hepatitis A and E pose a heavy risk and require urgent preparedness as they are historically recorded epidemics after floods. Meanwhile, stagnant water provides a breeding source for mosquitoes, thereby causing a surge in vector-borne diseases (). Shelter overcrowding has amplified acute respiratory infections, scabies, skin infections, and secondary wound infections, while tetanus risk is fueled in trauma cases due to a lack of timely prophylaxis. Polio resurgence is also a major threat, fueled by hurdles in immunization campaigns due to severe flooding, as Pakistan remains one of the only two polio-endemic countries ().
3 Multi-layered intervention strategies and recommendations
3.1 Strengthening surveillance and early warning systems
A multipronged, disciplined system for syndromic surveillance and vector control should be administered across all the affected districts. In order to safeguard the population of Pakistan and to protect global health safety, rapid diagnostic tests (RDTs) should be coupled with surveillance systems, especially for cholera, dengue, and malaria (, ). Internally displaced person camps and settlements should be assessed for systematic symptoms of watery diarrhea, undifferentiated febrile illness, febrile jaundice, hemorrhagic fever, and neurological syndromes. For further validation of the rapid testing, provincial laboratory networks should maintain confirmatory microbiology assessments. Surveillance outcomes should adhere to the guidelines provided by Pakistan's National Institute of Health Integrated Disease Surveillance and Response (IDSR), including recommended minimal datasets that are shared regularly through weekly public bulletins ().
3.2 Frontline clinical management and AMR response
In post-flood Pakistan, clinical management requires reinforced, agile stewardship fused with conventional field triage (). Mobile antimicrobial stewardship teams, armed with simple traffic-light antibiotic decision charts, must deploy with every field clinic to shape frontline antibiotic rules. Community sentinel nodes must host rapid, multiplex tests for cholera, dengue, malaria, and typhoid, catalyzing rapid differential diagnostics ().
For acute watery diarrhea and cholera, rehydration supply pathways and intravenous reuse remain the core response, with isolation capacity added. Avoid generic fluoroquinolone for typhoid; instead, patients should step to resistance-informed, higher-tier treatment pathways, layered with culture-based vigil for XDR tracking.
For dengue, algorithm adherence is paramount; guard against unnecessary antibiotics and antiphlogistic misuse, and restrict platelet transfusions to clear clinical indications to avoid wastage. Include malaria test-and-treat tactics insisting on appropriate artemisinin-based combination therapy, in tandem with G6PD screening before primaquine/tafenoquine in Plasmodium vivax (, ). Wound standards stress early debridement and tetanus for a time. To facilitate prompt clinical decision-making, field clinics and laboratories should promote quick, two-way communication. Beyond single clinical measures, water hygiene and availability, and biodiversity management must rise to a clinical role (–).
3.3 Integrated WASH and vector control
Emergency chlorination, targeted at both the source and household levels, combined with turbidity control, elevated latrines, and managed washing zones, continues to disrupt waterborne transmission (). A broad circle of residents must maintain container hygiene, and regular volunteer sweeps curb algal breeding hotspots. When drains and latrines overflow with turbid water, rapid repair nets the flow back. Over the same stretch, vector suppression adds control: short-lifecycle larviciding, indoor residual spraying at temporary sites, and community pack-outs of nets, mosquito repellents, and window screens ().
3.4 Building systemic resilience
To complete the protective package, immunization protocols must include oral cholera vaccines where available, universal tetanus boosters for newly wounded, and dose-targeting for hepatitis among dense relocation settings, all layered atop WASH, behavioral change, and environmental safeguards (). Climate adaptation funds and loss-and-damage financing should be directed at improving laboratory capacity, resilient water systems, and mobile health outreach, with equity weighting focused on children, pregnant individuals, recent displacees, and inhabitants of peripheral sites.
4 Conclusion
Pakistan's recent flood starkly illustrates how shifting climate patterns amplify arboviral risks, notably dengue, positioning the country as an instructive prototype for neighboring states and demanding long-term multi-sectoral solidarity (). The anticipated monsoon inundations of 2025 now emerge as both a sentinel event and an empowering reference point, one that the international infectious-disease fraternity must scrutinize to advance preparedness agendas for global safety and wellbeing.
Statements
Author contributions
JI: Conceptualization, Writing – review & editing, Writing – original draft. KF: Formal analysis, Writing – original draft, Data curation, Investigation. KB: Resources, Project administration, Writing – review & editing. SA: Resources, Writing – review & editing. MT: Writing – review & editing, Supervision, Validation. IS: Writing – review & editing, Validation.
Funding
The author(s) declared that financial support was not received for this work and/or its publication.
Conflict of interest
The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Generative AI statement
The author(s) declared that generative AI was not used in the creation of this manuscript.
Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
1.
AliedMSalamASediqiSMKwaahPATranLHuyNT. Disaster after disaster: the outbreak of infectious diseases in Pakistan in the wake of 2022 floods. Ann Med Surg. (2023) 86:891–8. doi: 10.1097/MS9.0000000000001597
2.
BaqirMSobaniZABhamaniABhamNSAbidSFarookJet al. Infectious diseases in the aftermath of monsoon flooding in Pakistan. Asian Pac J Trop Biomed. (2012) 2:76–9. doi: 10.1016/S2221-1691(11)60194-9
3.
MakwanaN. Public health care system's preparedness to combat epidemics after natural disasters. J Family Med Prim Care. (2020) 9:5107–12. doi: 10.4103/jfmpc.jfmpc_895_19
4.
SiddiquiEKhalidMKhanMSWaafiraA. Polio resurgence in Pakistan: unraveling the causes and addressing the consequences. Infect Ecol Epidemiol. (2024) 15:2447092. doi: 10.1080/20008686.2024.2447092
5.
BilalWQamarKAbbasSSiddiquiAEssarMY. Infectious diseases surveillance in Pakistan: challenges, efforts, and recommendations. Ann Med Surg. (2022) 78:103838. doi: 10.1016/j.amsu.2022.103838
6.
HaqZUFazidSHussainBKhanMFBetanniABehrawarBet al. Assessment of the impact of integrated disease surveillance and response system on surveillance management at healthcare facilities in Pakistan. East Mediterr Health J. (2024) 30:109–15. doi: 10.26719/emhj.24.026
7.
NisarNIqbalZSartaajMIkramAJavadNAliKet al. Mortality associated with priority diseases in flood-affected areas using district health information system (DHIS2) during September–December 2022: Pakistan experience. Disaster Med Public Health Prep. (2024) 18:e89. doi: 10.1017/dmp.2024.77
8.
Raza M Fatima A Habiba U and Shah HH. Public health implications of severe floods in Pakistan: assessing the devastating impact on health and the economy. Front Environ Sci. (2023) 11:1091998. doi: 10.3389/fenvs.2023.1091998
9.
WASH Challenges and Localised Solutions in Flood Affected Regions in Pakistan: An exploratory research study - Pakistan. ReliefWeb. (2024). Available online at: https://reliefweb.int/report/pakistan/wash-challenges-and-localised-solutions-flood-affected-regions-pakistan-exploratory-research-study
10.
SLD. Floods: Governance Challenges and the Roots of Repeated Climate Disasters in Pakistan – SLD. (2025). Available online at: https://sld.com.pk/2025/07/22/floods-governance-challenges-and-the-roots-of-repeated-climate-disasters-in-pakistan/ (Accessed August 20, 2025).
Summary
Keywords
flood, disaster and risk management, disaster surveillance, infectious disease, climate change
Citation
Ikram J, Farhan K, Baloch K, Ayaz SN, Tariq MB and Salomon I (2025) Hydrometeorological shocks to infectious-disease systems: lessons from Pakistan's 2025 floods. Front. Public Health 13:1697850. doi: 10.3389/fpubh.2025.1697850
Received
02 September 2025
Revised
25 November 2025
Accepted
27 November 2025
Published
15 December 2025
Volume
13 - 2025
Edited by
Jia Chenghao, Zhejiang University, China
Reviewed by
Saeed Khan, Dow University of Health Sciences, Pakistan
Hao Wang, Zhejiang University, China
Updates
Copyright
© 2025 Ikram, Farhan, Baloch, Ayaz, Tariq and Salomon.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Izere Salomon, izesajw73@gmail.com
ORCID: Kanza Farhan orcid.org/0009-0002-6211-7522 Khushbakht Baloch orcid.org/0009-0005-2368-610X Syeda Nashrah Ayaz orcid.org/0009-0000-9453-9899 Muhammad Burhan Tariq orcid.org/0009-0000-6908-0836 Izere Salomon orcid.org/0000-0003-3067-560X
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.