Mumps outbreak escalates

Health officials say they do not know why the number of cases shot up by 10 folds in the last two years 

Health: With at least two persons infected with the mumps virus every day in the last 11 months, mumps remains the most infectious disease reported in schools across the country this year.

In the last four months alone, a total of 445 cases were reported up from 299 cases reported between January and August this year. The figure, health officials say, is alarming compared to the outbreaks in the previous years but they admitted they do not know why the number has escalated.

Mumps is a highly contagious viral infection with an incubation period of 14-18 days from exposure to onset of symptoms. The virus usually spreads through saliva affecting the parotid salivary glands. These glands are found toward the back of each cheek, in the area between the ear and jaw. In cases of mumps, these glands typically swell and become painful.

The number of outbreaks reported fluctuated each year since 2010. The least number of outbreaks was reported in 2013 at 20, which increased by more than ten folds to 206 last year.

While health officials said the absence of a vaccine could be one of the reasons, there is no diagnosis on what could have caused the cases to shoot. Between 2010 and 2012, a total of 678 outbreaks were reported.

Safe for symptomatic treatment where infected people are given oral medicines and care advises, no vaccines are available in the country to treat the infection unlike in other neighbouring countries.

However, the number of mumps outbreak could decline beginning next year should all go as planned and the health ministry’s plan to introduce MMR (Measles Mumps Rubella) vaccines come through.

Programme officer of the vaccine preventable disease programme, Tshewang Tamang said this new vaccine currently used by other WHO member countries would replace the current MR (Measles Rubella) vaccine. However the cost of replacing the vaccine will more than double.

Annually Nu 3.8M (Nu 32 per dose) is spent on buying MR vaccines. The health ministry estimates that the annual cost will increase to Nu 6.65M in buying MMR vaccines, he said.

The Japan Committee for Vaccine through UNICEF that funds the vaccines’ purchase is positive about funding the increased costs.

“Although there is no mortality due to mumps infection, the increasing cases is a cause of concern,” he said. “Complications are less and most outbreaks occur in crowded areas such as schools.”

Meanwhile, after no outbreak was reported for the last two years, the health ministry saw six measles cases this year. The latest outbreak was reported in Phuentsholing hospital on December 7.

Tshewang Tamang said although Bhutan is on its way towards eliminating measles a year or two year before the WHO target, few outbreaks are expected.

“We’re sustaining a high immunization coverage so no major outbreaks are reported,” Tshewang Tamang said. “Those few cases are reported in people who travel across the border.”

Beginning August this year, the Department of Public Health launched the National Early Warning, Alert and Response Surveillance System (NEWARS). Since then the system receives information either via Short Message Services (SMS) or online, from health centres across the country on possible diseases outbreaks.

The information is then investigated and verified by officials at the Public Health Laboratory (PHL) in Thimphu.

Records with NEWARS show that there were 115 chickenpox outbreaks in the last four months.

Nirmala Pokhrel

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