Zero dengue and malaria deaths in 2020

Younten Tshedup  

If it weren’t for the 20 plus indigenous malaria (locally transmitted) cases detected this year, Bhutan could have achieved the malaria-free status by 2023, as per the revised target of the health ministry.

Following a minor outbreak of malaria in one of the gewogs in Sarpang, the country saw about 50 plus cases of the infectious disease this year. This included 21 indigenous malaria cases in Norbugang village under Sershong gewog in Sarpang.

The village is close to the Indian settlement across the border. Today, cross-border transmission of malaria including dengue fever is one of the major challenges in controlling the seasonal outbreaks in the country.

The Covid-19 pandemic is also attributed to the cases detected this year, as malaria surveillance was restricted as a result of lockdown in the border areas.

After failing to achieve zero indigenous malaria cases in 2018, the health ministry revised its target to 2020. For a country to achieve a malaria-free status, it has to maintain zero indigenous malaria cases for three consecutive years, according to the World Health Organisation.

A new target has been set. Bhutan aims for malaria elimination (zero incidence of indigenous malaria) by 2022. If Bhutan maintains this status for three consecutive years, the country would achieve malaria-free status by 2025.

A major concern during the summer this year was that a double-burden from a dengue or malaria outbreak in the south could hamper the Covid-19 containment efforts. However, there were no major issues and no deaths were recorded from the two infectious diseases this year.

According to officials from the health ministry, Bhutan has achieved a decline of 90 percent in malaria morbidity and mortality this year as compared to 20 years ago. Since 2019, no malaria deaths have been recorded and since 2016, less than 100 cases were reported annually in the country.

However, dengue fever has emerged as a disease of serious public health concern in the country since recording the first outbreak in 2004. Officials said that although intermittent cyclical outbreaks of dengue occurred, the 2019 outbreak was, by far, the worst in the country with over 5,000 cases detected and six deaths reported from the epicentre in Phuentsholing.

The cases were reported from 19 of the 20 dzongkhags in the country. All the cases reported from other dzongkhags had travel history to Phuentsholing. Vector surveillance had also confirmed the presence of dengue vectors, Aedes aegypti, in most of the dzongkhags in Bhutan.

This year the national surveillance system recorded 1,049 suspected dengue cases, predominantly reported from Phuentsholing (75 percent).

The overall reduction in the dengue fever and malaria transmissions this year, officials said, was because of a series of strategies and intervention put in place by the ministry.

Before the onset of monsoon, officials said massive social mobilisation and community engagement activities were conducted in Phuentsholing. Health ministry trained over 500 members from various groups to engage them in reaching each household in their localities.

An operational plan for preparedness and response to prevent and control dengue was also developed. The national guideline for clinical management of dengue fever, surveillance guidelines and reporting systems were revised.

The ministry also distributed over 143,000 long lasting insecticidal nets (LLIN), implemented insecticide residual spraying (IRS) in high-risk areas along the southern part of the country before the transmission season.

Along with its development partners (WHO, UNICEF and UNFPA), officials said that the collaboration at all levels — dzongkhag, thromde and gewog — attributed to the success so far.