Investigation of Suspected Peripheral Neuropathy Outbreak in Dechentsemo Central School, Thinleygang, Punakha

Abstract

Background: A suspected peripheral neuropathy outbreak was reported from Dechentsemo Central School, Thinleygang, Punakha, following which the investigation team was immediately dispatched in the field.Objective: The aim of investigation was to ascertain the cause and risk factor for the outbreak in order to implement control measures.Methods: A case control study was devised for the investigation to study about the past exposure or deficiencies in order to find out the suspected cause and risk factors. A semi-quantitative food frequency questionnaire was administered to both cases and controls to collect information on the type of food they have consumed. The information garnered was analyzed using Chi-Square or Fischer Exact test for categorical variables and Man-Whitney U-test for quantitative variables. Results: All 17 cases were females with mean age of 13 years (SD 2.7 years). The average daily amount of thiamine intake was 0.6 mg/day for case and 0.8 mg/day for controls against the recommended daily allowance (RDA) of 1.2 mg/day. Case and control patients differed significantly with respect to fat intake (p-value = 0.02), more strongly with folate and iron intake (p-value 0.01).Conclusion: The outbreak of peripheral neuropathy in Dechentsemo Central School appears to be linked to reduced dietary intake rich in vitamin B1 coupled with low intake of folate and iron in their diet.

Peripheral Neuropathy Outbreaks in Bhutan, 2020–2021

“…The current outbreak was dominated by males (68%) and this could be because two of the three events occurred in institutes with high proportion of male, unlike in a previous study which found that all PN cases were female. 10 We also found that there was no significant difference in average ThDP level among the different age groups. Despite all the current outbreaks being reported from the Eastern region of the country, the limited sample size prevents generalizing thiamine outbreaks to this particular geographical location.…”

“…9 Thiamine deficiency cases have previously been reported in Bhutan affecting young school-going students with loss of productive time and a few reported deaths. 10,11 Pradhan et al, (2021) found that infantile beriberi was the main cause of infant mortality (>70%) in Bhutan. 12 In 2017 several sporadic thiamine deficiency outbreaks were recorded in Bhutan among school children, thus fortified rice supplementation was initiated.…”