As part of efforts to develop an informed policy for rotavirus vaccination, this prospective study was conducted to estimate the burden of rotavirus diarrhea among children less than 5 years old attended to the Department of Pediatrics, Jigme Dorji Wangchuk National Referral Hospital (JDWNRH), Thimphu, Bhutan. The duration of the study was three years, extending from February 2010 through December 2012. We estimated the frequency of hospitalization in the pediatric ward and dehydration treatment unit (DTU) for diarrhea and the number of events attributable to rotavirus infection among children under 5 years of age. During the study period, a total of 284 children (1 in 45) were hospitalized in the pediatric ward, and 2,220 (1 in 6) in the DTU with diarrhea among children residing in the Thimphu district. Group A rotavirus was detected in 32.5% and 18.8% of the stool samples from children hospitalized in the pediatric ward, respectively. Overall, 22.3% of the stool samples were rotavirus-positive, and the majority (90.8%) of them was detected in children under 2 years of age. From this study, we estimated that the annual incidence of hospitalization in the pediatric ward and DTU due to rotavirus diarrhea was 2.4/1000 (95% CI 1.7–3.4) and 10.8/1000 (95% CI 9.1–12.7) children, respectively. This study revealed that rotavirus is a major cause of diarrhea in Bhutanese children in Thimphu district and since no study has been performed previously, represents an important finding for policy discussions regarding the adoption of a rotavirus vaccine in Bhutan.

To develop aninformed policy for rotavirus vaccination, this prospective study was conductedto estimate the burden of rotavirus diarrhea among children less than 5 years oldattending the Department of Pediatrics, Jigme Dorji Wangchuk National ReferralHospital (JDWNRH), Thimphu, Bhutan. The duration of the study was three years, extendingfrom February 2010 through December 2012. We estimated the frequency of hospitalizationin pediatric ward and Dehydration Treatment Unit (DTU) for diarrhea and thenumber of events attributable to rotavirus infection among children under 5years of age. During the study period, a total of 284 children (1 in 45) werehospitalized in pediatric ward, and 2,220 children (1 in 6 children)  in Dehydration Treatment Unit (DTU) withdiarrhea among children residing in the Thimphu district. Group A rotavirus was detected in 32.5% of the stoolsamples from the hospitalized children in pediatric ward and 18.8% in DTU withdiarrhea. Overall, 22.3% of the stool samples were rotavirus-positive, and the majority(90.8%) of them was detected in children under 2 years of age. From this study,we estimated that the annual incidence of hospitalization in ward and DTU s dueto rotavirus diarrhea was 2.4/1000 (95% CI 1.7–3.4) and 10.8/1000 (95% CI9.1–12.7) children, respectively. This study revealed that rotavirus is a majorcause of diarrhea in Bhutanese children in Thimphu district and represents animportant finding to policy discussions regarding the adoption of a rotavirusvaccine in Bhutan since no study has been performed previously.

Objectives: The coronavirus disease 2019 (COVID-19) pandemic, caused by a dynamic virus, has had a profound global impact. Despite declining global COVID-19 cases and mortality rates, the emergence of new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants remains a major concern. This study provides a comprehensive analysis of the genomic sequences of SARS-CoV-2 within the Bhutanese population during the pandemic. The primary aim was to elucidate the molecular epidemiology and evolutionary patterns of SARS-CoV-2 in Bhutan, with a particular focus on genetic variations and lineage dynamics. Methods: Whole-genome sequences of SARS-CoV-2 collected from Bhutan between May 2020 and February 2023 (n=135) were retrieved from the Global Initiative on Sharing All Influenza Database. Results: The SARS-CoV-2 variants in Bhutan were predominantly classified within the Nextstrain clade 20A (31.1%), followed by clade 21L (20%) and clade 22D (15.6%). We identified 26 Pangolin lineages with variations in their spatial and temporal distribution. Bayesian time-scaled phylogenetic analysis estimated the time to the most recent common ancestor as February 15, 2020, with a substitution rate of 0.97×10–3 substitutions per site per year. Notably, the spike glycoprotein displayed the highest mutation frequency among major viral proteins, with 116 distinct mutations, including D614G. The Bhutanese isolates also featured mutations such as E484K, K417N, and S477N in the spike protein, which have implications for altered viral properties. Conclusion This is the first study to describe the genetic diversity of SARS-CoV-2 circulating in Bhutan during the pandemic, and this data can inform public health policies and strategies for preventing future outbreaks in Bhutan.