Normal CD4 Count in Healthy Voluntary Blood Donors in the Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan

Aim: This study aimed to estimate the normal CD4 counts in healthy Bhutanese blood donors. Study Design: A prospective descriptive study. Place and Duration of Study: This study was carried out in the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Thimphu, between July 2015 to April 2016. Methodology: We recruited healthy blood donors in the JDWNRH collecting demographic characters and blood samples from consenting donors. Blood samples were analyzed using the BD FACS count system. Results: A total of 413 healthy blood donors, 288 (69.7%) males with a mean age of 27.3 years (18-62 years) were enrolled. Ethnically, 351 (85.0%) were northern and 62 (15.0%) were southern Bhutanese. The mean CD4 count was 668.3 cells/µl (range 259 -1591 cells/µl) and the median was 663 cells/µl. Females had significantly higher counts (p=0.004) and CD4 counts also significantly increased with increasing age but these differences were numerically small. Ethnicity did not produce significant differences in the CD4 count. In about 21% of the participants, counts were below the reference ranges and published data for Indians and Caucasians but comparable to other Asian, Middle East and African population. Conclusion: Upon validation with a larger study, a somewhat different CD4 cutoff may be required for the Bhutanese population. However, within the Bhutanese population, a single reference count may be advocated for adults disregarding the negligible numerical differences between age groups and gender.

Scrub typhus in Bhutan: a synthesis of data from 2009 to 2014.

Scrub typhus is an acute, febrile illness, caused by the bacterium Orientia tsutsugamushi, that affects millions annually in the endemic Asia-Pacific region. In untreated cases, the case-fatality rates range from 6% to 35%. In Bhutan, there was a probable outbreak in Gedu in 2009, which resulted in heightened awareness of the disease. Nevertheless, information on scrub typhus in Bhutan is limited and scattered and the epidemiology has yet to be established. To report the current picture of scrub typhus in Bhutan, this review gathered data from scholarly databases, surveillance reports, the Annual health bulletin, research publications and laboratory test reports from hospitals. The weight of evidence indicates an increasing burden of scrub typhus since the Gedu incident, coupled with increased awareness and testing. Another outbreak in a rural primary school in 2014 resulted in two deaths. More hospitals now have testing facilities and laboratory-confirmed cases have been increasing since 2009, with seasonal trends. This review highlights the need for in-depth surveillance and reporting, increased awareness among health-care workers, and initiation of prevention and control programmes in the country.