Abstract
OBJECTIVE: Describe the influenza A(H1N1) pandemic in Bhutan. DESIGN: Observational study from sentinel surveillance sites. SETTING: Bhutan remains isolated, with only one to two flights a day at the lone airport, no trains, and only three major roads that enter from India. MAIN OUTCOME MEASURES: PCR positive human respiratory samples. RESULTS: The first case of A(H1N1)pdm09 infection was detected in Bhutan in July 2009, 3 months after the virus was first reported in Mexico in April 2009. During the official WHO pandemic period (11 June 2009 to 8 August 2010), a total of 2149 samples were collected and tested by RT-PCR of which 22.7% (487) were confirmed A(H1N1)pdm09; H3N2, H1N1, and B were positive in 2.2%, 1.1%, and 7.2%, respectively. The highest rate of A(H1N1)pdm09 cases (57.4%) was detected in the 6-20 year-old age group. Importantly, Bhutan increased from 3 sentinel sites in April 2009 to 11 a year later, and in April 2010 established PCR capability for influenza. CONCLUSIONS: Despite relative isolation, the A(H1N1)pdm09 reached Bhutan within 3 months of identification in Mexico. The H1N1 pandemic has made Bhutan more prepared for epidemics in the future.