A review on foodborne disease outbreaks in Bhutan.

Foodborne diseases (FBDs) are a public health threat that can result in loss of lives and are a hurdle to socioeconomic development. The Foodborne Disease Burden Epidemiology Reference Group estimated that the annual burden of FBDs in the South-East Asia Region was more than 150 million illnesses, causing about 175,000 deaths. This review paper aims to compile evidence from the published articles and gray literatures on food-related disease outbreaks in Bhutan. Information was generated from the annual health bulletin published by the Ministry of Health and data from the National Early Warning Alert Response Surveillance and Information System hosted by Royal Centre for Disease Control. The laboratory confirmation rate of FBD investigation outbreaks increased from 25.5% (2012-2018) to 91.7% in 2020, as per the National Food Safety Indicator (FSI). At least 0.15% of the total population had suffered FBD from 2015 to 2020, and the baseline report shows that most of the FBD events occurred during hot and wet seasons (June and August). The common pathogen causing FBD was Salmonella species accounting for 42.9% of cases, followed by Shigella species (21.4%). Most of the FBD events were reported in schools (46.5%). The frequency of the reported FBD outbreaks had increased from 8 events in 2015 to 15 events in 2017 and 10 events in 2018. The study confirms the improved surveillance for FBDs in Bhutan and highlights the need to raise public awareness on food safety.