Background:On 11th 2012, Langthel BHU staff called CMO over five students suffering from legs swelling from Langthel Lower Secondary School. After consultation with CMO, the students were referred to Trongsa hospital on 12th June for further clinical investigation. Following examination/investigation, the cause of an outbreak was suspected as nutritional deficiency. On 14th June, the team comprising DHO, CMO and BHU staff visited Langthel LSS to investigate.

Finding:Clinically, all five students examined in the hospital had bilateral legs swelling with no other sign and symptoms associated. However, one case had high blood pressure. Lab result showed low protein level in the blood. During the investigation in the school, 12 additional students were found having/had history of similar symptom (bilateral leg swelling). Out of 17 cases; 9 were old and 8 were new cases. All cases complained leg swelling on and off. All were border students except for the one. The school menu revealed mostly carbohydrate rich diet.

Conclusion:Probable Nutritional deficiency (protein and multi vitamin) may be the cause of the current outbreak.

Background:On 14th May 2012 (around 10.00 AM), an outbreak of acute gastroenteritis (AGE) in Nganglam Higher Secondary School was reported to Public Health Laboratory by Medical Officer (MO) of Nganglam BHU-1. Cause of an outbreak was initially suspected food poisoning.

Objective:To verify and confirm acute gastroenteritis outbreak

Methodology:All AGE cases were interviewed to ascertain source of an outbreak. Stool sample were collected from some cases and tested in lab. Environment investigation was carried at school water source and in the school kitchen. Water samples were collected from source till taps of the school for quality testing.

Results:All cases had diarrhea and adnominal cramp associated with fever, nausea and vomiting. An overall attack rate of an AGE outbreak was 28% however, sex specific attack rate was observed high among girls (40%) compare to boys (20%). Affected age group ranges from 15 - 21 years. Water was found grossly contaminated at source till tap points in the school and organism isolated from stool was Shigella species.

Conclusion:The causative agent of an outbreak was confirmed as Shigella species and source of an AGE outbreak was found to be contaminated water. Risk factor linked to an outbreak was student’s habit of drinking water directly from tap.