The threat of vector-borne diseases in Bhutan

In order to control vector-borne diseases in the country, the Ministry of Health (MoH) will observe the World Health Day in Phuentsholing with the theme of vector-borne diseases on April 7. A clean up campaign will also be held on the day.

The Chief Program Officer (CPO), Rinzin Namgay, of the vector-borne disease control programme (VDCP) said, “Most of the outbreaks occur in Phuentsholing area, in fact, three kinds of vector-borne disease are seen in the place, be it malaria which is an age-old disease, dengue fever and chikungunya outbreak, which first broke out in 2004 and 2012 respectively.”

There are also cases of scrub typhus, a disease transmitted by chigger-mite, seen in Chhukha. Hence, Phuentsholing has been chosen, of all the places, to observe the day.

The CPO, VDCP said, “If not treated, all vector-borne diseases are deadly.” He explained that in malaria cases, if not treated, the plasmodium falciparum malaria can cause death within 24 hours.

Likewise, dengue, although believed to be mild, has different strain types ranging from one to four. If a person is detected with virus type one and next time if he gets type one, he will be immune to that virus. However, contracting any other different virus types will be fatal.

Number of cases and deaths caused in Bhutan There are six kinds of vector-borne diseases recorded in the country.

In 1994, the country’s case load of malaria was over 40, 000 which drastically reduced to 82 cases then to 16 cases in 2013. However, 4 deaths were caused due to malaria in 2009 which reduced to 2 death cases in 2010 and one death in 2012 and 2013 .Malaria, is caused by ‘Anopheles’ mosquito has been there for long time back.

Dengue was first detected in 2004 with over 2000 cases. The numbers drastically reduced to 11 cases in 2005 which later saw in increase in number of cases to 874 in 2010. A fluctuation in the number of cases in dengue has been observed over the years. The highest number of death due to dengue was reported in 2009 with 8 deaths and reduced to 4 deaths in 2010.Last year saw 111 cases with zero case of death since 2011.

Chikungunya which was detected for the first time in 2012 saw over 2,500 cases in Phuentsholing and Samtse with no record of deaths.

Dengue and chikungunya are transmitted by ‘Aedes’ mosquito.

Kala-azar, transmitted by sand-flies, was first detected in 2006 with eight cases in Mongar (in places like Kengkhar, Kalapang, Daksa,Gongdu), Zhemgang, Yalang in Trashiyangtse and Tsirang saw sporadic cases. The figure last year was 4 cases.

Scrub typhus, a diseases transmitted chigger-mite, was detected for the first time in 2008 from Tsimalakha Hospital. 7 cases were detected from Gelephu in 2013 and similarly from Nganglam and Bongo every year.

Japanese encephalitis (JE), a mosquito-borne diseases is transmitted by ‘Culex’ mosquito, around 2-3 cases was recorded recently for the first time in Gelephu and Samtse as per the official records.

In addition to that, recently liptospirosis, which is transmitted through rat’s urine, was first detected in the country with 2-3 cases.

Though there is a decrease in number of malaria cases in Bhutan, however, there are risks because people don’t use mosquito nets and residual spray thinking that there are no more malaria cases in their villages.

“Even when they get fever, they don’t go to health centers for diagnosis and this is why we have risks, there is a need to strengthen our information, education and communication (IEC),” Rinzin Namgay said.

Compared to national cases, the cases (imported cases) within migrant workers, especially those employed by Punatsangchhu and Mangdechhu projects were higher in number. There was 16 indigenous cases and 30 imported cases recorded last year.

Rinzin Namgay said such imported cases can spread within the country and is a huge concern for the team fighting the spread of vector-borne diseases.

As a part of intervention by the VDCP, Rinzin Namgay said, “Our main focus is on malaria whereby residual spray of 2 rounds is being done every year and also providing LLIN (long lasting insecticidal net). That has co-benefit, which has co-effectiveness in other vector- borne diseases such as dengue, JE, kala-azar and so on,” he said.

Tashi Deki / Thimphu


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