The Bhutanese Leading the way.
Every year, the country reports influenza cases, but this year, there have been an increasing number of influenza outbreaks in the country. A majority of the flu cases were reported from schools, which means there is an influenza outbreak in the community as well.
Head of the Royal Centre for Disease Control (RCDC), Dr Sonam Wangchuk, said influenza occurs seasonally, and now around this time is the season for it, and there will be outbreaks and cases will be there. But this year, the cases reported are higher than in the past years.
There are two possible reasons for the increased cases of influenza. Dr Sonam said every year country reports influenza A, B and C, but in the last two years, only a few cases were reported because of the lockdowns and fewer number of people moving around, and also the COVID-19 safety measures, such as wearing face masks, social distancing and hand washing helped to minimize transmission. So now, Bhutan has come back to its pre-pandemic status, and there are no interventions, which is why many influenza cases are being reported.
Dr Sonam said outbreak happens according to season and also depends on the types of influenza variant viruses. According to RCDC surveillance, currently, the predominant virus is the influenza A (H3) variant virus and it is expected that there will be a lot of flu cases in the country. Although the number of cases will be high, however, the severity will be less. Severity depends because some strains cause more severity and some may not. There might be severe cases in the community but according to the people visiting the hospital, RCDC has not received or reported any severe cases of influenza so far, Dr Sonam added.
“We don’t know the true number of cases and they say there is COVID-19 strain too. As the COVID-19 strain changes, people will be infected. New strains are imported from other countries but at this point, a lot of people are suffering from influenza only,” said Dr Sonam.
Flu season varies but Bhutan has two peak flu seasons, it is November and December and it will continue till February. During extreme cold, there will be not many cases but when the weather gets warm, again people will start catching the flu. The other one is during the monsoon season. It all depends upon changes in strains and also the weather which favours the transmission. This year it is a little bit early because there have been a lot of outbreaks in October.
According to Mongar Regional Referral Hospital, isolated severe cases of flu-like illness have been reported in Mongar. There may be an outbreak of the same, especially in places where mass gathering exists, like in schools and religious institutions.
As per the influenza-associated respiratory hospitalization burden study conducted by RCDC in 2017, the estimated influenza-associated respiratory hospitalizations among all ages is 376 per 100,000 in 2015 and 896 per 100,000 in 2016 respectively. The estimate significantly varies from season to season due to continuous changes of influenza viruses.
The most affected age groups were children less than 5 years and elderly people above 65 years. The National Immunization Technical Advisory Group (NITAG) has recommended that influenza vaccination be given during the months of November and December every year.
Dr Sonam said if any people are suffering from influenza and if it is severe such as coughing or breathing problems, they should visit the health center, and not wait for it to go away thinking that it is just normal flu. Actually, flu is self-limiting and it should go on its own, but then a few people might suffer and become severe. So, it is always good to have symptomatic management and medical care at the health center.
Meanwhile, influenza vaccination started on 2 November 2022 to the high-risk population comprising the elderly population (65 years and above), children (6 months to less than 2 years), health workers and people with chronic medical conditions. The flu shot will protect these high-risk populations from getting severe infection.
