When the monsoon season started in Pakistan in July this year, clinicians and public health experts were fearing an increase in vector-borne diseases including dengue fever and malaria in urban areas of the country. But the spread of dengue viral infection before the formal end of monsoon was beyond their expectations. In the past, the number of dengue cases had started increasing in September and the peak occurrence was seen in October.'When reported dengue fever cases started increasing in August this year while it was still raining in Karachi, we were a little surprised.

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