Until July this year, about 130 suspected cases of measles and rubella were reported in the country.

Of the total cases, about 15 were positive.

Bhutan became one of the first two countries to eliminate measles in the WHO South-East Asia Region (SEAR) before the regional target of 2020 in June 2017.

Senior Programme Officer with the vaccine preventable disease programme, Tshewang Dorji Tamang, said people travel to the border areas which increases the risk of measles virus importation.

Measles is a highly contagious disease. It is easily spread through coughing, sneezing and close contact with those already infected. The symptoms are fever, cough, red eyes, muscle aches, runny nose, white spots inside the mouth and rash for any age.

Tshewang Tamang said that most of the positive cases were reported from Thimphu and Paro. This, he said, was because there is frequent travel of people of the two dzongkhags to the border town areas.

He said the programme with the ministry immediately responds to any cases reported to prevent further transmission of the disease. “We also investigate the cases.”

Based on the investigation and genotype of the measles, it is confirmed that the reported cases are imported, he said.

WHO’s definition of elimination of measles means zero indigenous cases in a country.

“Bhutan has eliminated measles doesn’t mean that there will not be any cases,” he said. “There will be cases reported but we have to investigate and have the evidence that the cases are of importation.”

According to the Royal Centre for Disease Control’s monthly disease epidemiology report, 44 suspected and one measles positive cases were reported last month. Of the reported cases, Paro reported the highest with 19 cases, followed by Chukha and Wangdue with five and four cases respectively.

Tshewang Tamang said to continue efforts against measles and rubella, Bhutan should protect high-risk populations to effectively deal with any importations and improve immunization coverage through routine immunization services targeting difficult to reach area and nomadic population.

As a response to any outbreak of disease reported in the country, including measles cases, a total of 9,544 people aged between nine months and 40 years were vaccinated in the last two months.

“We need to strengthen the investigation and reporting especially outbreak investigation and measles surveillance,” he said.

To sustain measles elimination status, Tshewang Tamang said that high measles, mumps and rubella vaccination coverage both first and second dose above 95 percent should be maintained at all level.

In Bhutan, the measles vaccine is given in the form of the measles, mumps and rubella vaccine (MMR vaccine) from 2016.

Until 2005, only measles vaccination was given but from April 2006, measles and rubella vaccine was introduced into routine immunization service.

The measles vaccination programme was first introduced in the country in 1979. The second dose of measles vaccination for children at 24 months was started in 2006.

Recently, WHO announced that Bhutan became one of the first six countries in the region to control rubella and congenital rubella syndrome (CRS).

A country is said to have achieved rubella control when it reduces the number of rubella cases by 95 percent.

Tshewang Tamang said rubella cases are low in Bhutan. “If a mother is infected with rubella during pregnancy then there is a high risk that the baby will get CRS.”

In 2006, rubella and measles vaccination were given to children aged nine months to 14 years of both the gender and to females aged between 15 and 45 years.

He said the objective to give to only the females aged between 15 and 45 years is to control CRS and to the children of nine months to 14 years to protect both cohorts in case of an outbreak.

Eliminating endemic measles and controlling rubella and congenital rubella syndrome by 2020 has been the flagship programme of the region since 2013. The strategy is based on four goals, including reaching and maintaining 95 percentage coverage with two doses of the measles and rubella vaccine.

Dechen Tshomo