Disease Outbreak Summary Report(as reported by district Hospital/BHU) for April 2015
Gomphu Lower Secondary School
Notifiable Diseases Summary Report for April 2015
ARI Out break
FluView_ILI & SARI Surveillance Report for Week 16, 2015
The incidence of ILI and SARI for the week was 44/1000 outpatient visits and 6/100
hospitalized patients respectively. The highest incidence of ILI and SARI cases were
reported both from Paro Hospitals respectively. The ILI cases were commonly observed
among age group 15-29 years while SARI cases were observed among 0-1 years age
group. From 29 samples received and tested by Real-Time RT-PCR, positivity rate was
A Prospective Hospital-based Surveillance to Estimate Rotavirus Disease Burden in Bhutanese Children under 5 Years of Age
As part of efforts to develop an informed policy for rotavirus vaccination, this prospective study was conducted to estimate the burden of rotavirus diarrhea among children less than 5 years old attended to the Department of Pediatrics, Jigme Dorji Wangchuk National Referral Hospital (JDWNRH), Thimphu, Bhutan. The duration of the study was three years, extending from February....
Outbreaks were investigated immediately by respective District
Health Officials with... Read More
Outbreaks were investigated immediately by respective District
Health Officials with
the help Public Health Laboratory. Rapid test
for suspected cases were done onsite and throat swabs were
collected for confirmatory test by RT-PCR for influenza viruses.
The PCR test was confirmed that Influenza A/pdmH1 subtype
viruses in Gaybakha, Yurung Locality, Mukhung Community Pry
School and Phochu Dumra Lobdra. In Ramjar Middle school, it
was confirmed Influenza A/H3 subtype viruses.
User Manuals for PHL Online Systems
Public Health Laboratory has developed user manual for following online systems:
Bhutan Diarrheal Study Information System (BDSIS)
National Notifiable Disease Surveillance Information System & Event Reporting Information System (NNDSIS/ERIS)
Bhutan ILI AND SARI Information System (ILI-SARI)
Tuberculosis Information & Surveillance System (TBISS)
Water Quality Monitoring Information System (WQMIS)
Outbreak Investigation Report On Scrub Typhus In Singye Namgyel Primary School, Wangduephodrang, 3rd-4th October 2014
Following the death of a 17 years old female student from Singye Namgyel Primary school Migtena village, Athang geog under Wangduephodrang district on 28/08/14 at JDWNR Hospital with provisional diagnosis of viral encephalitis, a rapid response team from Wangduephodrang visited the area and mitigation measures were implemented. Another 8 years old female student expired on 28/09/2014 from same school (referred from Punakha Hospital). She was suspected of meningococcal-meningitis. Similarly, a 10 years old female student from same school was referred from Punakha Hospital on 29/09/2014 with similar sign and symptoms to that of the deceased. These numbers of similar cases following the death of two school children has alerted the public health department and mandated to intervene.
Dominance of Emerging G9 and G12 Genotypes and Polymorphism of VP7 and VP4 of Rotaviruses from Bhutanese Children with Severe Diarrhea Prior to the Introduction of Vaccine
Bhutan is a small landlocked country located between India and
China. Part of the population is concentrated in the capital
Thimphu, but most are scattered sparsely throughout the country.
Diarrhea is a major cause of illness and death in Bhutanese
children, and the morbidity rate from diarrhea in ,5 years old
children is 314.6/1,000 population [1,2], while 13% of deaths are
attributable to diarrhea . Approximately 83% of the population
have access to safe drinking water and 91% have access to sanitary
toilets . A shift from bacterial to possibly viral diarrhea has been
observed, although information regarding childhood diarrhea is...
National Workshop on Severe Acute Respiratory Infections (SARI) Surveillance,Bumthang,1-3 October,2014
The SARI surveillance system is one of the important surveillance systems in the country which was established for monitoring trends in respiratory illnesses and to understand the epidemiology of influenza viruses and other respiratory pathogens by Public Health Laboratory.
Establishing a good system through periodic training of health personnel will ensure obtaining good data which will help better understand the epidemiology and impact of influenza and other important respiratory pathogens in the country for policy formulations.
and Medicla Laboratory Technicians from 1-3 October 2014 with following objectives:
Familiarize participants on Severe Acute Respiratory Infection Surveillance system in Bhutan
Improve sensitivity and specificity of existing surveillance system for both SARI surveillance through proper identification and selection of cases.
Sensitize laboratory personnel on proper collection of specimen, packaging and transport of specimen for accurate diagnosis.
Identify the participants as the Surveillance Focal Point from wards and laboratories of sentinel sites.
Preliminary Report on Surveillance for Diarrhea Etiologic Agents at Public Health Laboratory in Stool
Specimens from Children in Bhutan, from July 2013 to August 2014
After the successfully completion of two years collaborative Surveillance between the
Public Health Laboratory and the Department of Enteric Diseases, AFRIMS, Bangkok
on Diarrhea Etiologic Agents in Stool Samples from Children Attending Jigme Dorji
Wangchuk National Referral Hospital (JDWNRH), Thimphu, the collaborative
surveillance on diarrhea etiologic agents has been extended to Eastern Regional
Referral Hospital (Mongar), Central Regional Referral Hospital (Gelephu) and
Phuntsholing General Hospital in July 2013 to further understand the epidemiology of
diarrhea etiologic pathogens among the Bhutanese children for another two years.
New cases and deaths attributable to EVD continue to be reported by the Ministries of
Health in Guinea, Liberia, Nigeria, and Sierra Leone. Between 12 and 13 August 2014,
152 new cases (laboratory-confirmed, probable, and suspect cases) of EVD and 76
deaths were reported from the four countries as follows: Guinea, 9 new cases and 3
deaths; Liberia, 116 new cases and 58 deaths; Nigeria, 0 new cases and 1 death; and
Sierra Leone, 27 new cases and 14 deaths.
Applications Invited for One Health Postgraduate Study Fellowships
Massey University is seeking applicants for One Health Postgraduate Study Fellowships as part of a 3-year program ‘Integrating Education and Action for One Health’ in Afghanistan, Bhutan, Nepal and Bangladesh. The program is funded by the European Commission under the One Health Program in Asia, and runs from 2014–2017.
Report on Entomological investigation of Malaria outbreak in Khawrong, Langchenphu, Jomotshangkha (3rd June 2013 to 9th June 2014)
The first two malaria cases were reported from a couple, Mr. TshetenDorji and Mrs. Tsheltrim Zangmo, who had seeked treatment in India. They are nomadic herders;they had cited that, since, treatment at Basic Health Unit required hospitalization, they preferred to get treated in India. No medical prescription was available with them, though, it was most likely that, they were treated by......
Epidemiology of dog bites and Rabies post exposure prophylaxis in Bhutan, 2009–2012.(Article under peer review)
Dog bites in human and expenses incur on anti-rabies treatment is a public health problem in Bhutan. In this study we describe the epidemiology of dog bites and the use of human rabies postexposure prophylaxis (PEP) vaccine in Bhutan for a period of four years (2009-2012). Dog bites and PEP treatment data (18,813 patients’) were retrieved from 34 health centres and performed descriptive and logistic regression analyses.
Dog bite incidents were found to be significantly higher in males than females and most common in children than adults. Similarly, males (n=10,924; 59.19%) received significantly ( P <0.001) higher PEP courses than females (n = 7849; 41.81%) across all age groups. The median age of PEP recipients was 20 years (range <1 to 93 years) and the modal age was 6 years. Children – particularly 5–14 years of age – received more PEP than other age groups. The study demonstrated that 57.12% (n= 10,746) of the patients received an incomplete PEP course (less than 4 doses)).
Multivariable analysis indicated that – sex and age of patients, type of exposure (animal bite versus non-bite), area of PEP (rabies risk/endemic versus rabies free ), season and year of PEP were associated with an incomplete PEP course.
Results suggest that females are more likely to complete PEPs than males and the adult patients are less likely to complete PEPs than children. Patients with animal bite injury were less likely to receive complete vaccine course than non-bite recipients, indicating
risk of rabies infection if exposure animal is in-fact rabid. Patients presented to hospitals in rabies endemic or outbreak areas (south Bhutan) were more likely to receive complete course than in non-rabies areas or rabies free areas. Similarly, comparing to the months in autumn,
patients presenting to hospitals for PEPs during spring and summers months were more likely to receive complete vaccine course whilst patients presenting during winter seasons are less likely to receive complete PEP course. This study provides valuable information on sources of exposure
and PEP in humans for policy discussion including dog population management and public education to reduce dog bite incidents and expenses on PEP in Bhutan.
Novel Human Bufavirus Genotype 3 in Children with Severe Diarrhea Bhutan(Published Article)
We identified a new genotype of bufavirus, BuV3, in fecal samples (0.8%) collected to determine the etiology of diarrhea in children in Bhutan. Norovirus GII.6 was detected in 1 sample; no other viral diarrheal pathogens were detected, suggesting BuV3 as a cause of diarrhea. This study investigates genetic diversity of circulating BuVs.
Multidrug-resistant Tuberculosis Patients in Bhutan, August 2011 to July 2012(Published Article)
This study aimed to describe the factors associated with multidrug-resistant tuberculosis (MDR-TB) in Bhutan. The study covered all MDR-TB patients admitted to Gidhakom Hospital, Thimphu from August 2011 to July 2012. Data were collected from MDR-TB registers, laboratory registers and inpatient records as well as from interview with patients about demographic characteristics, history of previous anti-TB treatment, compliance and contact history. There were total 19 MDR-TB patients. Majority of the patients were males (63%). Median age was 25 years for males and 30 years for females.
Molecular Characterization and PCR-based Replicon Typing of Multiple Resistant Shigella sonnei Isolates from Bhutan(Published Article)
During a diarrhea surveillance study in Bhutan 2011, Shigella sonnei were isolated more frequently than expected. Twenty-nine S. sonnei isolated from Bhutan were characterized
for antimicrobial susceptibility, integrons, gyrA gene mutation, replicon typing, plasmid and PFGE analysis.
Rotavirus burden 2013 manuscript(Article under peer review)
During the study period, a total of 284 children (1 in 45) were hospitalized, and 2,220 children (1 in 6 children) attended the outpatient clinic with diarrhea. Group A rotavirus was detected in 5% of the stool samples from the hospitalized children with diarrhea.
Overall, 22.3% of the stool samples were rotavirus-positive, and the majority (90.8%) of them was detected in children under 2 years of age. From this study, we
estimated that the annual incidence of hospitalization and outpatient visits due to rotavirus diarrhea was 2.4/1000 (95% CI 1.7�3.4) and 10.8/1000 (95% CI 9.1�12.7) children, respectively.
Influenza surveillance from November 2008 to 2011;including pandemic influenza A(H1N1)pdm09 in Bhutan(Published Article)
The first case of A(H1N1)pdm09 infection was detected in Bhutan in July 2009, 3 months after the virus was first reported in Mexico in April 2009. During the official WHO pandemic period( 11 June 2009 to 8 August 2010), a total of 2149 samples were collected and tested by RT-PCR of which 22.7% (487) were confirmed A(H1N1)pdm09;H3N2,H1N1 and B positive in 2.2%, 1.1% and 7.2%, respectively.
In 2012, chikungunya virus (CHIKV) was reported for the first time in Bhutan. IgM ELISA results were positive for 36/210 patient samples; PCR was positive for 32/81. Phylogenetic analyses confirmed that Bhutan CHIKV belongs to the East/Central/South African genotype. Appropriate responses to future outbreaks require a system of surveillance and improved laboratory capacity
A One Health approach involving joint activities amongst human, animal and environmental sectors for the control of zoonoses has received increasing attention in recent years given the high proportion of emerging infectious diseases originating from animal species,such as avian influenza (H5N1, H1N1), Severe Acute Respiratory Syndrome (SARS), antimicrobial resistance, Nipah virus and others.
The Regional Training Program in Animal and Human Health Epidemiology in South Asia that has been implemented by Massey University, New Zealand, on behalf of seven countries in the South Asia region has significantly contributed to the development of the One Health approach in this region over the past four years. This program has been funded by the European Commission Avian and Human Influenza Trust Fund and administered by the World Bank.
The aim of the Program has been to strengthen institutional capacities in epidemiology and biosecurity through epidemiology training and operationalizing the One Health concept in national government institutions responsible for control of zoonoses.The program in Bhutan, implemented by the Department of Health and Department of Livestock, has been based on two Collaborative Investigation Projects (CIPs): one to support rabies control and the other to evaluate collaboration and communication between the human and animal health sectors. These CIPs have provided the focus for staff from the human and animal health sectors to work together in designing and implementing the projects and in the supporting epidemiological training activities. The network of people involved in the CIPs forms the basis of the One Health Hub Bhutan (OHHBh).
A specific focus of this Program has been to strengthen professional collaborative networks amongst animal and public health personnelwithin each country and the South Asia region through establishment of a government-endorsed OHH in each of the seven countries, linked to form the regional �One Health Network - South Asia�.
We are currently working to strengthen the OHH in each country by expanding the focus of the OHH from supporting the CIPs to supporting the wider range of One Health activities in the country for managing endemic and emerging zoonotic diseases.
Hubnet is a web-based communication and collaboration system that has been set up through the Regional One Health Training Program. This system provides a secure online environment for each One Health Hub to share information and resources amongst its own members and to publicise information on One Health activities, projects and useful resources to members of OHHs in other countries and other interested parties through the Regional One Health Network-South Asia.Hubnet is a regional platform for strengthening communication and collaboration to support the One Health approach both within each country and within the region.
For additional information,please Click Here to visit our website.
To register as a One Health Hub Bhutan member, please download the Membership Registration Form and email the completed form to firstname.lastname@example.org or email@example.com