Lhakpa Quendren

Gelephu—At least five malaria cases have been reported in Sarpang within a week. However, the investigation to identify the source of infection is encountering obstacles due to patients who are not forthcoming about their travel history.

The reported cases involve four males from Char, three of whom are from the same family and the other is a neighbour. Their ages range from 25 to 61 years old. A 20-year-old female from Menchhulam in Gakiling was also affected.

While three cases were detected on April 19 and another on April 24, the female was detected on April 25. The patients are currently being treated at the Sarpang General Hospital and the Gelephu Central Regional Referral Hospital (CRRH).

Char is about 5km from Sheychamthang town. Menchhulam, located 8km from Char, is seeing its first malaria case after 16 years. There is no presence of mosquitoes in either village, according to officials from the Vector-borne Disease Control Programme (VDCP) in Gelephu.

As there have been no locally acquired malaria cases in the country, officials are investigating whether these cases were imported.

The last local cases (indigenous) were reported in Sarpang in 2021.

Officials also suspect that the infections may have originated from the recent religious (Puja) event in Gakiling, which was attended by devotees from neighbouring towns across the border.

The first patient had a travel history to Muray, Assam in the second week of April, officials said. However, considering the incubation period of 14 to 17 days, and his frequent visits to the event, the case detection coincides with the religious event that ended on April 2.

“Initially, none of the patients reported travelling outside before falling ill. We had to ask their relatives and neighbours,” said an official. “Nothing is conclusive at the moment. The investigation will be completed this week.”

Another official said that some people travel through illegal routes, hindering investigation efforts and case classification. “If they travel through the proper routes, we can trace them using the Check Post Management System (CPMS).”

This is the first malaria case in Sarpang and the second in the country this year. The first malaria case (imported) this year was reported in an incoming official recently.

Measures and challenges

Following the detection of the cases, public health responses and containment measures were implemented.

VDCP officials said that four-day reactive screenings were conducted within the affected areas, and indoor residual spraying (IRS) was used in houses to control mosquitoes.

“The entire population in the 10 households in Lower Char was screened. We will conduct another screening after 14 days of incubation in those high-risk areas to determine if the infections are spreading,” said an official.

VDCP also initiated several cross-border meetings with the Indian counterparts over the years.

“We have also proposed a joint screening in their areas, but we are yet to receive a response. We also report the detected cases in our locality immediately to our counterparts to ascertain whether there are cases in their areas,” he added.

Bhutan revised its deadline to eliminate the disease twice, in 2018 and 2020. If no indigenous malaria cases are detected by 2022, Bhutan will obtain WHO malaria-free certification by 2025.

Malaria is a severe, sometimes fatal illness usually transmitted by mosquitoes. While the disease does not spread directly from person to person, mothers can transmit malaria to their fetuses during pregnancy or to their infants during delivery.