The Bhutanese Leading the way.
Bhutan was officially declared one of the first two countries in South-East Asia Region (SEAR) of WHO to eliminate measles before the regional target of 2020. In recognition to this, Bhutan achieved a Citation as an appreciation from the WHO SEARO at the 70th Session of WHO Regional Committee in Maldives.
The first measles vaccination program in Bhutan was started in 1979 for the infant of 9 months. To accelerate measles immunization coverage, the 1st nationwide measles immunization campaign was conducted in 1995 covering age group 9 months to 15 years old followed by 2nd Measles nationwide Measles immunization campaign was conducted in 2000 covering age groups 9 months to 15 Years old covering around 98%.
The 3rd Measles and Rubella nationwide immunization campaign was conducted in 2006 covering age group 9 Months to 15 years old covering 97% followed by introduction of second dose of MR vaccine into routine immunization schedule in 2006 at the age of 24 months.
However Dr. Karma Lhazeen, the Director of Public Health Department said that the measles elimination does not mean there will no cases reported a few few sporadic cases is expected.
After zero reported cases of measles in 2013 and 2014, despite having good Measles surveillance and coverage, small measles outbreaks during 2015, 2016 and 2017 was experienced.
“It was in isolated pockets of susceptible populations in geographically difficult terrains and migrant populations in border areas.” She said that every measles case reported in the country was investigated and confirmed through geno typing and epidemiological investigation to be imported cases. “Bhutan sustained high Measles and Rubella immunization coverage over the last 10 years”
She said the main challenge remains in porous border due to its risk of importation of measles from countries that have not reached elimination stage and highly mobile nomadic populations, in labour camps and road side camps who may miss their routine vaccinations and over a period of time the un vaccinated population can accumulate to higher numbers and focal outbreaks can take place.
So far, the Ministry of Health (MoH) with the support from WHO and UNICEF conducted measles and Rubella catch up immunization campaign in high risk populations example nomadic population and border area populations and Dantak laborer camps and vaccinated over 60,000 population in the age group 9 months to 40 years. “This supplementary immunization activity has been conducted from August 1 to 14, 2017 in the high risk areas to increase the immunization coverage and population immunity against the measles and rubella.”
She said the campaign will ensure that any unvaccinated person from 9 months to 40 years living in the high risk border areas and unreached pockets are immunized and protected. “Even if any cases are imported into the country outbreaks will not happen if the population of Bhutan are immunized against measles”. Without the campaign she added that population immunity gaps will continue to exist, which can be a threat for future measles elimination strategies to the country as well as to the region.
In order to sustain measles free status in a country, routine measles, mumps and rubella 2nd doses will be covered at all levels followed by disease surveillance and case investigation including outbreak investigation.
The ministry is further working on strengthening the capacity of Measles and Rubella laboratory for early investigation and reporting and conduct Measles and Rubella catch up immunization campaign as and when required. “We will also strengthen regular monitoring and supervision at all level along with periodic review at national level with districts and relevant stake holder” she added.
