Heavy rainfall and poor sanitation to blame among others
The first endemic dengue outbreak in Bhutan was reported in 2004 in Phuentsholing with more than 2,000 cases.
However, it generally started declining with 850 cases in 2016, 240 cases in 2017 and only 20 cases in 2018.
However, 2019 has seen a huge upsurge since as of August 2019, there were 1,538 cases of dengue in the country focused mainly in Phuentsholing.
The Phuentsholing hospital contributed the highest numbers, with 1,148 cases followed by CRRH Gelephu with 70 cases. The least number of cases was reported from Jomotsangkha BHU I with just 3 cases.
The rest of the cases was reported from Gedu hospital (44), Tsimalakha hospital (14), Doksum, Trashiyangtse (57), Sarpang hospital (30), Samtse hospital (34), Gomtu hospital (6), Sibsoo hospital (13), Samdrupjongkhar hospital (15), Samdrupcholing BHU I (10), Damphu hospital (8), Lhamoizingkha hospital (18) and Paro (20).
Chief Planning Officer of Communicable Diseases Department, Ministry of Health, Rinxin Jamtsho, said most of the patients who are detected with dengue in other districts have the history of travelling to Phuentsholing prior to their illness. Cases detected in Paro are all those who have travelled to Phuentsholing and it is not that they got infected while staying in Paro, he said.
In a day, Phuentsholing hospital receives 40 to 50 cases on average, and sometime the number of cases in a day goes up to 60 to 70, and this has lead to a total of 889 cases of positive dengue cases in the month of August alone.
Likewise, the emergency Department of JDWNRH has received 46 cases in just August, which are mostly cases referred from district hospitals.
Dengue has caused two 2 deaths so far in Bhutan this year. A 28-year-old man died on 21st August in JDWNRH and a 26-year-old female died on 11th August in Phuentsholing hospital. It is, therefore, crucial to detect dengue in its early stages for a cure.
Rinxin Jamtsho, said that the first case of Dengue was detected in Phuentsholing on 5 July, and since then the disease has been on rise day by day.
He said, “The most probable cause for the outbreak this year in Phuentsholing is due to the heavy rainfall and flood. The other causes are poor sanitation across the border town and water shortage in Phuentsholing.”
A survey shows that the rate of dengue is higher among females (55 percent) compared to males and the median age was 26 years, ranging from 1 to 68 years.
He said that 32 percent of the dengue patients who were diagnosed in Phuentsholing hospital are those who are residing in Jaigaon. However, to this, the Jaigaon counterpart responded that dengue outbreak blame has to be taken by both bordering towns of Phuentsholing and Jaigaon.
“They have recommended to carry out a cleaning campaign once a week, all day workers are to be screened and there will be active case surveillance,” Rinxin Jamtsho added.
There are numerous challenges while dealing with such outbreaks, such as poor response and level of awareness and self-protection by public, Rinxin Jamtsho added.
He said the survey had shown 56 percent of respondents kept empty containers, barrels, tyres with stagnant water in their surroundings, 53 percent do not use mosquito nets and 65 percent do not use mosquito repellents.
In addition, he also said that 88 percent of respondents wore short pants and shirts with short sleeve, 56 percent of the respondents kept flowerpots and they are not aware about importance of inspecting those pots for mosquito larvae.
The other challenges are continuous rainfall and the space crunch at the hospitals, he added. “We need to have equal intervention. Despite so much of awareness programs, people are being irresponsible,” he added.
As an immediate response to the outbreak, a response team has been stationed in Phuentsholing conducting thermal fogging everyday, house-to-house vector surveillance and control by checking empty containers, refrigerators, etc.
He said that they also have mobilized additional health staff, stationed team from VDCP and RCDC and they also have planned to mobilize medical camp kits if the situation becomes uncontrollable.
Schools, major public gathering, public transportation, like buses and taxis, are being used as platforms to create awareness on the prevention of dengue. Pamphlets with precautionary messages are being distributed to the public as well.
Rinxin Jamtsho shared that to prevent such an outbreak in the future, the department is looking deeper into strategies and operational plan capacity building for dengue management, develop an early warning system, strengthen vector surveillance system and strengthen collaboration and coordination with stakeholders.
Meanwhile, Phuentsholing Thromde involving all the community will carry out a mass cleaning campaign on Saturday.
There are Phuentsholing residents who also question the Thromde for not carrying out proactive measures like cleaning campaigns and removal of mosquito breeding places given the town’s past history of dengue cases. They point to how Gelephu has much lower cases.
A complicating factor is that the haphazard and large bordering town of Jaigaon requires cross border cooperation to control the issue.