According to the surveillance for influenza (flu), conducted by RCDC, there are two seasons in Bhutan when the flu virus spread is most rampant. The first season is from December to March, and the second season lasts from July to September.
Flu virus is one of the most notorious viruses on the planet which cause regular outbreaks and epidemics during seasons and periodic pandemic. Influenza illnesses range from mild to severe and even death mainly among high-risk groups. Globally, the World Health Organization (WHO) estimates show, about 3- 5 million cases of severe illness and 3-7 hundred thousand deaths due to influenza epidemics annually.
Therefore, the National Immunization Technical Advisory Group (NITAG) has recommended influenza vaccination for winter season in November and December every year. It is expected to help reduce influenza-associated hospitalization and death especially due to pneumonia in children below 24 months in the country. In addition, instituting the vaccination program into the routine immunization services at all the hospitals will also provide platform to deploy influenza vaccine for general population during pandemic.
Health Minister Dechen Wangmo said that looking at the data, the influenza virus, itself, will not kill the person but it will induce co-morbidities. Citing an example, Lyonpo said when vulnerable groups, such as children or the elderly people catch the flu, and then they are most at the risk of getting pneumonia which can be fatal. The flu vaccination will also be given to health work as they are in direct contact with patients daily.
Lyonpo Dechen Wangmo said the flu vaccination will have a huge benefit for the nation. She added that the flu vaccination was launched on the eve of the government turning one, as it was their promise to the nation and they managed to mobilize the funding from Royal Centre for Disease Control (RCDC) and Bhutan Health Trust Fund (BHTF).
Meanwhile, Chief Program Officer with the Communicable Disease Division (CDD), MoH, Rixin Jamtsho, during the launch, said that in Bhutan, respiratory illness is one of the top ten diseases affecting all age groups. As per the influenza-associated respiratory hospitalization burden study conducted by RCDC in 2017, the estimated influenza-associated respiratory hospitalizations among all ages were 376 and 896 per 100,000 in 2015 and in 2016 respectively.
“This estimation 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 above 65 years. The lesson learnt from influenza epidemics and pandemics show that the preparedness is critical to reduce severity and death,” he said.
The vaccine is targeted for 5 categories of risk groups, he said, adding that they are pregnant women, patients with chronic medical condition, elderly population 65 years and above, children 6-23 months and health workers involved clinical work.
Some of the symptoms of the flu are fever, cough, sorethroat, runny nose, muscle or bodyache, headache, feeling weak or more tired than usual and sometimes diarrhoea and vomiting.
The world will experience influenza pandemic periodically but it is very difficult to predict the timing, as influenza virus evolves constantly in every season. For this very reason, WHO is emphasizing on ways a country can develop pandemic preparedness and response plan, and conduct regular simulation to test the plan.
“Bhutan has developed national influenza pandemic preparedness and response plan (NIPPRP) in 2015, and one of the main strategies is to introduce influenza vaccine in the country,” Rixin Jamtsho said. In line with this plan, NITAG has recommended to introduce influenza vaccine for the high-risk groups.
The health ministry has explored funding support to introduce influenza vaccination into the routine immunization service. The influenza vaccine for pregnant women and health worker is supported by the Task Force for Global Health through Partnership Influenza Vaccine Introduction (PIVI) under United States of America Centers for Disease Control and Prevention (US-CDC), while the vaccine for children less than 24 months, elderly above 65 years and chronic medical condition is supported by BHTF.
Currently, the ministry received 88, 000 doses of flu vaccine worth of Nu 6.16 million. “The country requires total of approximately 107,600 does of influenza vaccine for three categories of risk groups amounting to Nu 8.46 million annually for 77, 000 targeted population,” Rixin Jamtsho added.
Health ministry introduced administering the influenza vaccination on 6 November. The influenza vaccine along with Pneumococcal Conjugate Vaccine (PCV) was launched in June 2018 for all five identified risk groups. He said, “However, vaccine could not be introduced in 2018 since it is seasonal vaccine and prior order has to be placed well in advance to the vaccine manufacturer.”
The flu vaccine will be provided for five identified high-risk groups in all health centers routine immunization service in November and December every year.