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Epidemiological analysis of the pandemic influenza A (H1N1) virus in Bhutan

2012; Elsevier BV; Volume: 16; Linguagem: Inglês

10.1016/j.ijid.2012.05.271

1878-3511

Sonam Wangchuk, Binay Thapa, Sangay Zangmo, Richard G. Jarman, Piraya Bhoomiboonchoo, Robert V. Gibbons,

Respiratory viral infections research

Background: Bhutan is an extremely rugged and mountainous country covering approximately 38,394 square kilometers ; the altitude ranges from 75m to over 7000m 1. The Ministry of Health in Bhutan had 3 sites for sentinel influenza surveillance when the World Health Organization declared a health emergency on 29 April 2009. The MOH increased the surveillance sites to 11 by May 2010 and established influenza PCR capability by April 2010. The first two cases of influenza 2009 pH1N1 cases were reported on 20 July 2009 from samples collected on 16 and 18 June 2009 from Thimphu, the capital. Prior to the pandemic PHL had three influenza surveillance sites, this increased to 11 by the spring of 2010. Methods: A suspect case was defined as a person with fever (≥380C) and cough or sore throat. Nasal and throat swabs were collected from those available within 72 hours of meeting the case definition after obtaining clinical and epidemiological data. The nasal swab was used for rapid testing (QuickVue) and the throat swab was put in viral transport media tube. Samples were tested by Polymerase chain reaction (PCR) and viral isolation methods at Department of Virology USAMC-AFRIMS, Bangkok, Thailand Results: During the pandemic period (11 June 2009 to 8 August 2010) 2264 samples were collected: 20.7% (467) samples were positive for pH1N1, 1.2% (27) for A/H1, 1.9% (44) for A/H3, and 6.9% (157) for influenza B. The first cases in 2009 occurred in Paro and Thimphu, with subsequent movement to Punakha. The mean age of those with pH1N1 was 19.5 years, trending to be younger than those with A/H1 (23.1 years), significantly older than those with A/H3 (16.9 years) and B (15.4 years). The first institutional outbreak of pH1N1 was in two schools from the eastern district of Trashigang in May 2010. In a span of two months, 20 outbreaks were reported in schools and institutes across the country. Out of 20 outbreaks, 16 were confirmed as pH1N1 and one as influenza B. Conclusion: The capability established during the pandemic has made Bhutan more prepared for epidemics in the future.