Lessons learnt as Dengue cases reach 4,300 with six deaths

As per the report from Communicable Disease Division (CDD), Ministry of Health (MoH), a total of 4,300 dengue positive cases in the nation was reported as of 15 November. A dengue outbreak was declared in Phuentsholing, Chukha in July 2019.

Dengue cases were reported from 19 dzongkhags. Lhuentse was only the dzongkhag spared from dengue. All the dengue cases reported from other districts were imported from Phuentsholing and other endemic places. All the patients were reported to have the travel history to the endemic areas.

Chief Program Officer of CDD, MoH, Rixin Jamtsho, said that 77 percent of the total cases were reported from Phuentsholing hospital excluding those tested by a few private diagnostic centers in Phuentsholing.

“Six deaths have been reported due to dengue including 2 maternal deaths. 3 to 5 cases of dengue are currently being seen by Phuentsholing hospital, and for now, the outbreak has not been declared to be over,” he added.

He said that the number of dengue detection is quite high this year because there was no dengue response plan in place, and no separate budget allocated for dengue management and outbreak response.

“If we had those in place then we could have prevented it, or the number wouldn’t be that high. Moreover, there were not much awareness programs on dengue in the past, and whatever had been in place was not that effective for the public,” he added.

In addition, he said that there were no cross border collaboration in the past, and today the maximum cases reported in Phuentsholing hospital are people residing at Jaigaon. “The reporting system was also inadequate, which is why the hospital did not report the cases to the ministry on time for immediate intervention,” he added.

Therefore, with what they have learnt from the past and for better prevention in future, they have designed numerous plans and strategies. As a part of the effort, to prevent such massive dengue outbreaks from next year, MoH has come up with various plans of which almost 50 percent of the plans have been already implemented this year.

A dengue operational plan is being developed for source reduction and destruction much ahead of rainy season. It includes capacity building of the health workers in dengue management and outbreak response and to strengthen the cross border collaboration, both at the central and local level.

In addition, he said, they will strengthen the early warning system, case investigation and reporting system, strengthen collaboration and coordination with stakeholders for prevention and control of dengue outbreaks, and strengthen vector surveillance and reporting system.

“We will also develop structured advocacy and risk communication plan and activate National Health Rapid Response Team and allocate separate budget for dengue management and dengue outbreak response,” he added. If they do not come up with such plans and strategy for future, then it could be risky, he said.

Meanwhile, he said that with aggressive intervention by the District Health Rapid Response Team (DHRRT) with support from Phuentsholing Dungkhag, Thromde, schools, colleges and communities, dengue was successfully brought under control much ahead of ending the dengue season, which actually ends only towards end of November.

DHRRT was inactivated from mid October after seeing the significant reduction in the number of cases. However, DHRRT and MoH are faced numerous challenges, like a cross border issues where 32 percent of the cases were from Jaigoan, India.

The other challenge they have faced is in terms of poor response on awareness and self protection by public and manpower capacity and staff constraint at the hospitals, he said.

He said, “As per the evidence of poor support and compliance by the public on awareness and advocacies from the surveillance report, 56 percent of respondents have empty containers, barrels, tyres with stagnant water in their surroundings, and 53 percent of the respondents do not use mosquito nets.”

In addition, he said that 65 percent do not use mosquito repellents, 88 percent of the respondents wear short pants and shirts with short sleeve, 56 percent of the respondents have flower pots in their balconies, and they are not aware about importance of inspecting those pots for mosquito larvae.

Of all, 35 percent of the dengue mosquitoes were seen breeding in the domestic refrigerator and barrel drums in the indoor survey and 58 percent and 16 percent of the dengue breeding places were tyres and flower pots respectively in the outdoor survey, he added.

Dengue fever is caused by any one of four types of dengue viruses spread by Aedes aegypti mosquitoes that thrive in and near human lodgings.

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