Bhutan eliminates measles before target

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

Measles is a highly contagious disease and the WHO SEAR Office has set the measles elimination target to 2020. In line with that, Bhutan had set up its own target to eliminate measles by 2018.

Bhutan and the Maldives are the first two in the region to be verified for having interrupted endemic measles virus transmission.

According to a press release from WHO South-East Asia Region (SEARO), regional director for WHO SEARO, Dr Poonam Khetrapal Singh while announcing the findings and conclusions of the WHO SEA Regional Verification Commission for measles elimination and rubella control, said the two countries have demonstrated how a highly contagious virus like measles can be eliminated. “WHO commends them for this momentous public health achievement.”

The regional director said the strongest political commitment, alongside concerted efforts of health workers, officials and partners at all levels, has helped achieve this landmark success, which is a boost to the Region’s effort to eliminate measles and control rubella.

Deputy chief programme officer with the vaccine preventable disease programme, Tshewang Tamang, said the ministry attributes the achievement to its dedicated health workers, partner supporters, and parents for bringing their child for immunization.

Bhutan did not report any measles case in 2013 and 2014. However, there was a measles outbreak in a school in Merak, Trashigang last year.

Tshewang Tamang said that in the case of the Merak outbreak, most of the infected were not vaccinated.

Of a total of 45 measles cases from Paro, Samtse, Sarpang, Thimphu, Trashigang and Wangdue last year, 33 were reported from Trashigang alone.

In 2015, some 11 measles cases were reported from Samtse, Paro, Sarpang, Phuentsholing and Thimphu.

The ministry investigated measles cases in 2015 and 2016.

Tshewang Tamang said that based on the investigation and genotype of the measles, it is confirmed that the cases are imported. He said that WHO’s definition of elimination of measles means zero indigenous case in a country and the transmission should not go beyond 12 months.

Bhutan has not reported any case of indigenous measles since 2012. The health ministry will carry out a measles catch-up campaign next month.

Tshewang Tamang said it is expensive for the ministry to conduct a nationwide campaign as required by the WHO and that the ministry will be campaigning only in selected areas in all the dzongkhags.

“We will focus on high-risk areas where immunisation coverage has been low, where measles outbreak cases has been reported and border areas to increase the immunity level of the population against measles,” he said.

Meanwhile, about 16 measles cases were reported from Samtse, Phuentsholing and Thimphu until April this year.

Tshewang Tamang said trans-boundary infection is the main challenge to eradicate measles cases in the country.

All countries in the region have introduced two doses of measles containing vaccine and making focused efforts and progress against measles and rubella.

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

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

Tshewang Tamang said it is mandatory for a child to get both the dosages. Unvaccinated children are at a higher risk of getting measles and suffering from complications. Any non-immune person who has not been vaccinated or was vaccinated but did not develop immunity can become infected.

“While endemic measles virus transmission has been interrupted, both Bhutan and the Maldives continue to be at risk of measles virus importation,” Dr Khetrapal Singh said. “Both countries must continue efforts against measles and rubella and protect high-risk populations to effectively deal with any importations.”

Dechen Tshomo

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