ANNUAL HEALTH BULLETIN 2004 - Ministry of Health

• EPI mid level management training was conducted for DMOs/DHSOs and primary
health workers from 2003 and on going activities.
• No. Cases ofMNT have been reported since 1994.
AFP Surveillance:
• Bhutan is a non-endemic country for poliomyelitis. The last case of clinically
compatible case of poliomyelitis was detected in 1986 in Tsirang Dzongkhag. But
due to its porous border with an endemic country, India, the risk of importation of
poliovirus is always there. Thus, in order to control measures, acute flaccid paralysis
(AFP) surveillance was initiated in later part of 1997.
• Since, 1997, 18 of AFP cases were reported and investigated and discard as nonpolio
by the national expert committee polio eradication.
During 2003 4 AFP cases was reported and active surveillance pick up one unreported
case of AFP from JDWNRH, Thimphu and stool result was inadequate because of late
collection and that case was referred to Kolkota for the further treatment. Now the case
has been investigated and discards as non-polio by the national expert committee.
Rubella.
Rubella was not a notifiable disease in the country. The new as well as the old hospital
and BHU reporting forms did not include rubella for routine reporting. No. Laboratory
testing facilities for rubella existed prior to April 2003. Though clinical suspicion of
rubella was made; there were no supportive diagnostic facilities.
Trongsa had an outbreak of febrile rash in 2003. This occurred in the municipality areas
as well as in some nearby villages. A total of five schools had the outbreak which had
laboratory confirmed rubella. There were six other Dzongkhags that reported similar
epidemics these were laboratory confirmed as rubella epidemic. In 2003 Public Health
Laboratory has received 179 sample of blood for analysis among which 35 samples
tested were from pregnant women from the outbreak area in Trongsa. All were negative
for rubella (IgM). These samples were tested for anti-measles IgM as well as antirubella
IgM.All the samples were negative for measles IgM. Fifty-five samples tested
positive for Rubella IgM among non-pregnant groups.