Pakistan continues to be dealing with a polio outbreak as four fresh cases have emerged, pushing the national tally to 37 this year, according to health officials on October 19, 2024. Health officials said that the regional reference laboratory for polio eradication at the National Institute of Health in Islamabad confirmed wild poliovirus type-1 (WPV1) in two children-one from each Balochistan and Khyber-Pakhtunkhwa.

In recent cases, a girl has been affected from Pishin, and two boys from Chaman and Noshki of Balochistan, and a girl from Lakki Marwat in KP. These are the first detections of the virus within Noshki and Lakki Marwat this year; isolated cases of poliovirus were previously reported within Chaman and Pishin. The province of Balochistan was the worst hit with 20 cases, Sindh had 10, Khyber Pakhtunkhwa had five, and Punjab and Islamabad had one case each.

A gigantic fight against polio has been on going in Pakistan- especially in Balochistan and southern KP-over the last two years. Immunisation campaigns have often been suspended or delayed because of local protests, insecurity, and community boycotts. Consequently, quite a number of children did not get the necessary vaccinations, making existing patches of vulnerability for the virus to flow within those pockets.

Noshki, located near Afghanistan's border, and Lakki Marwat have also recently reported some positive environmental samples that confirm the virus is present here, said a local reference laboratory official. Samples of latest cases are currently under genetic sequencing for checking spread of virus and origin.

As the threat of polio continues to grow, Pakistan has vowed to mount a nationwide campaign against it beginning from October 28. With the zeal to tackle the menace in the most effective manner, over 45 million children under the age of five will be vaccinated across the country.

Today, Afghanistan and Pakistan remain one of the few countries where polio has not yet been eradicated. The WHO said the virus remains a potential serious public health threat in areas with low vaccination coverage and weak surveillance.

India On Alert Against Polio

The country declared itself polio-free since 2014 and has kept the disease on bay almost a decade with very robust vaccination programs; however, two cases of vaccine-derived poliovirus cases reported in recent days from Meghalaya create some amount of doubts over a possible resurgence. Experts observe that in India, despite these detections taking place, strong coverage of vaccination at 90-95% and mandatory surveillance measures keep the risk of this widespread outbreak at bay.

The experts point out, however, that such stable situation in India requires continued surveillance. "Countries like Pakistan and parts of Africa remain at a high risk because vaccination rates in those areas are much lower," Dr. Siddharth, public health expert, said. Vaccination is an indispensable act in order to avoid the spread of this incapacitating disease that manifests most importantly as a nervous system affliction leading to the paralysis of a long period.

With concerted efforts from health authorities, there is hope someday that the scourge of polio will be completely eradicated from the face of the earth and future generations will never suffer from its effects.

Kerala has reported 70 cases and four deaths due to shigellosis (bacillary dysentery), a highly contagious bacterial disease caused by Shigella bacteria, during June alone.

The southern state has recorded a total of 146 cases and five deaths from the intestinal infection since the beginning of the year, according to state Health Minister K. Muraleedharan. While one death was reported in March, the remaining four occurred in June.

Out of the 146 cases, 74 were reported in Kozhikode district, followed by 25 cases in Malappuram, including two deaths. Thiruvananthapuram also reported 25 cases, according to figures released by the minister.

No Shigella cases have been reported this year from Pathanamthitta, Palakkad, or Kasaragod districts.

A one-year-old child undergoing treatment for Shigella infection in the intensive care unit of Kozhikode Medical College Hospital remains in critical condition.

Why Children Are Most Vulnerable

Also read: Kerala Battles Triple Burden: Shigella, Nipah And West Nile Cases

Young children are particularly vulnerable to the disease, which is primarily spread through contaminated food, contaminated water, and poor hygiene practices.

Of the five deaths reported in Kerala this year, four occurred in children under the age of 10. Shigella infections tend to be most severe in children below five years because their immune systems are less efficient at clearing the infection.

Dr. Rajeev Jayadevan, former President of the Indian Medical Association (IMA) Cochin and Convener of the Research Cell, Kerala, explained that the bacteria's resilience contributes to its spread.

“Shigella is able to withstand the hostile acidic environment of the human stomach. Outside the human body, it can stay alive in water for weeks together,” he told HealthandMe.

He added that even a very small number of bacteria—as few as 10 organisms—can cause infection.

Drug-Resistant Shigella Rising In The US

In April, the US Centers for Disease Control and Prevention (CDC) highlighted growing concerns about drug-resistant Shigella strains in its Morbidity and Mortality Weekly Report.

The report noted that changes in epidemiology and antibiotic resistance are transforming Shigella from a largely self-limiting infection into an emerging public health threat with limited treatment options.

According to the CDC, oral carbapenems, pivmecillinam, and fosfomycin may be effective against some resistant strains. However, none have been approved by the US Food and Drug Administration for treating shigellosis.

“Treatment of XDR shigellosis remains challenging because no optimal therapy has been established,” the report stated.

While Kerala's cases have largely been reported among young children, outbreaks in the United States have been more commonly reported among adult men, highlighting sexual activity as a potential route of transmission.

The CDC estimates that approximately 450,000 Americans develop shigellosis each year. Although most patients recover with rest and hydration, severe cases may require hospitalization.

Read More: One Month Into DR Congo Ebola Outbreak, Cases Cross 800 As Crisis Deepens

Shigella: Symptoms And Mode Of Transmission?

Shigella can spread through:

• Touching contaminated surfaces or objects
• Physical contact with an infected person
• Drinking contaminated water
• Consuming ice made from contaminated water

Symptoms usually develop within one to three days after exposure and may initially include:

• Fever
• Diarrhea
• Body aches
• Headache
• Bloody diarrhea
• Severe abdominal cramps

How to Prevent Shigella Infection

Oral Rehydration Solution (ORS) can help prevent dehydration, while zinc supplementation may aid recovery.

Other preventive measures include:

• Washing hands thoroughly with soap and water, especially before handling food and after using the toilet
• Maintaining strict hygiene among food handlers
• Controlling flies and preventing food contamination.

India’s Union Ministry of Health and Family Welfare has issued a notification ending the over-the-counter (OTC) sale of all syrups, including cough syrups.

Under the new rules, a doctor's prescription will now be required to purchase cough syrups across the country.

“Consequently, the sale and dispensing of cough syrups in smaller villages will now be required to take place only through duly licensed pharmacies in accordance with the provisions of the Drugs and Cosmetics Act, 1940 and the Rules framed thereunder,” the notification said.

Why Are the Rules Being Amended?

The amendment comes months after contaminated cough syrups were linked to the deaths of 22 children in Madhya Pradesh and Rajasthan, raising fresh concerns over the safety and regulation of commonly used liquid medicines.

Following the incident last year, health authorities in India had banned three cough syrups Coldrif, Respifresh TR and ReLife after traces of diethylene glycol (DEG) were detected in the products. The Coldrif contamination was linked to the deaths of 22 children in the country.

“The amendment has been undertaken to strengthen regulatory oversight of syrup formulations and to align the exemption framework with contemporary public health and safety requirements,” the notification said.

“The measure is expected to promote responsible distribution and sale of cough syrups while ensuring greater compliance with regulatory standards across the country,” it added.

Also read: Introducing Eggs Before Age One May Lower Allergy Risk by 17%, Says Study

Experts Welcome Move To Restrict Cough Syrup Sales

Dr Kuldeep Kumar Grover, Associate Director, Pulmonology and Critical Care, CK Birla Hospital, Gurugram called it a

"a good initiative to include all syrup varieties, cough syrups included, under prescription medicines".

Cough syrups have substances that might lead to drowsiness, addiction, or drug interaction in patients who do not seek medical advice before taking the medicines.

"It is important to note that a cough could be a symptom of other serious conditions like infections, asthma, and allergies. Prescription-based access encourages proper evaluation, accurate treatment, and safer medication use," Grover said.

Dr. (Prof.) Mohsin Wali, former Physician to the President of India, said cough syrups and similar formulations often contain suppressants such as codeine and dextromethorphan (DXM), along with other solvents.

Dr. Wali, Senior Consultant and Head of Preventive Cardiology at Pacific One Health, recalled previous incidents in which contaminated Indian-made cough syrups were linked to deaths in Gambia and other African countries.

"Industrial-grade solvents were detected in some of these products, leading to kidney failure, severe metabolic acidosis, and, in some cases, death," he said.

According to Dr. Wali, the new notification will help curb the overuse, misuse, and addictive use of cough syrups while improving patient safety.

What Did The Notification Say?

The Ministry notified an amendment to the Drugs Rules, 1945, through Gazette Notification G.S.R. 927(E) dated December 29, 2025, published in the Gazette of India Extraordinary, Part II, Section 3, Sub-section (i), dated December 30, 2025.

The amendment omits the word “Syrup” from Schedule K, Serial No. 13, Entry 7 under the heading “Class of Drugs.”

Schedule K of the Drugs Rules, 1945, provides exemptions from certain provisions of the Drugs and Cosmetics Act, 1940, and the rules framed under it for specified classes of drugs.

Before this amendment, Entry No. 13 of Schedule K permitted the sale of cough syrups in villages with a population of less than 1,000 without requiring compliance with certain retail sale licensing provisions.

With the omission of the word “Syrup” from the entry, this exemption will no longer apply to cough syrups.

Manufacturers, distributors, and retailers dealing with cough syrups have been advised to ensure strict compliance with the applicable licensing and regulatory requirements under the Drugs and Cosmetics Act, 1940, and the Drugs Rules, 1945.

Ban On Pediatric Cough Syrups

Last year, India formally prohibited the use of certain commonly available OTC cough and cold medicines in children below the age of four.

The policy move, notified through a gazette notification, banned a fixed-dose combination (FDC) of Chlorpheniramine Maleate and Phenylephrine Hydrochloride—two ingredients commonly found in pediatric cough syrups.

The decision followed growing global concerns over the safety of these medicines in very young children, with India joining several countries that have introduced stricter regulations.

Countries including the United States, Canada, and the United Kingdom had previously issued guidelines or warnings regarding the use of OTC cough and cold medicines in young children.

One month has passed since the Democratic Republic of the Congo (DRC) declared its 17th Ebola outbreak, and there is no sign of respite. Confirmed cases and deaths have surged to 808 and 192, respectively, according to the country's Health Ministry.

Uganda has confirmed 19 infections, while Congo's Ituri province, where the outbreak first emerged, accounts for more than 90% of cases in the country.

The outbreak was reported to the World Health Organization (WHO) and the outbreak was officially declared on May 15.

The cases continue to surge daily as health authorities and aid agencies grapple with inadequate testing, weak contact tracing, and community resistance.

However, experts warn the outbreak's true scale may be far greater than official data indicate, making it already the third-deadliest Ebola outbreak on record.

Ebola Epidemic Moving Upward

Also read: Ebola Survivors May Face COVID-Like Memory Loss and Brain Issues For Over 7 Years: NIH Study

According to Dieudonne Mwamba Kazadi, head of the DRC National Institute of Public Health (INSP), the Ebola epidemic was still moving upward in Bunia, the capital of Ituri province and the epicenter of the outbreak, Xinhua News Agency reported.

"We are still in the midst of the epidemic. I would say we are in the upward phase of the outbreak, the active phase," Kazadi said.

More confirmed cases are expected in the coming days, making it urgent to expand treatment capacity and establish new Ebola treatment centers in affected areas, he noted.

"The perspective is really to increase capacity and already have treatment centers positioned to receive the future suspected and confirmed cases that we will identify in the coming days and weeks," Kazadi said, stressing the need to "engaging communities further," he said.

True Scale of Outbreak Remains Unclear

Read More: Expert Explains Science Behind Ebola Patient Recoveries

Medical charity Medecins Sans Frontieres (MSF) said in a statement that the government's figures likely understate the true toll of the outbreak, echoing concerns raised by aid groups and some Congolese officials.

"No one knows the true scale or exactly where the disease is spreading in DRC," said Kate White, MSF's emergency medical coordinator.

"One month on, the Ebola disease outbreak is outpacing the response effort," White said.

She noted that most treatment centers in Ituri province are overwhelmed, with many patients arriving at a late stage of the disease.

"What we do know is that most treatment centers in Ituri province are overwhelmed; many of our patients arrive at a late stage of the disease, and the majority were never identified or monitored as contacts before seeking care," White said.

Testing and Contact Tracing Challenges

Testing remains "one of the most significant weaknesses in the response," according to the MSF statement.

WHO Director-General Tedros Adhanom Ghebreyesus said he was “really worried” about the outbreak after visiting the DRC, Stat News reported.

“When the community is not taking it as its priority, it’s very hard,’’ Tedros said. He said that in the North Kivu, South Kivu, and Ituri provinces where the outbreak is centered, Ebola is seen as a lesser evil compared with armed conflict, widespread hunger, and more common deadly diseases experienced daily.

Notably, many communities, particularly those affected by active armed conflict, still lack access to test kits. Treatment centers are also facing significant delays in receiving laboratory results, hampering efforts to quickly identify and isolate infections.

What Is Ebola?

Ebola is a highly lethal viral hemorrhagic fever first identified in 1976. Over the past five decades, it has caused over 30 outbreaks, primarily in Central and West Africa.

Symptoms include fever, headache, weakness, vomiting, diarrhea, muscle pain, sore throat, and unexplained bleeding. This eventually leads to severe complications like bleeding, organ failure, and death.

Aid groups warn that without stronger surveillance, faster testing, and improved contact tracing, the outbreak could continue to expand in the weeks ahead.