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Dress cultureis one of themain factors for difference in sex ratio with regards to dengue incidence in Bhutan

Dengue is emerging as a serious public health problem globally, with 2.5 billion people at risk and 50 million dengue infections occurring annually. This disease is one of the most significant public health problems in tropical and subtropical countries, and is increasingly being detected in traditionally non-endemic areas. Bhutan was also among non-endemic area for dengue but after 2004 this diseases came in predominance. The initial study on the limited acute-phase blood samples in and around Phuntsholing [urban town bordering India] during 2004 to 2006, showed DENV-2 (Cosmopolitan genotype) predominated in 2004, and DENV-3 (genotype III) predominated in 2005–2006. The study revealed the probable entry of these viruses from India and primary dengue infections suggested recent emergence and establishment of local transmission. Dengue infections affect all age groups and produce a spectrum of clinical manifestations, with varied clinical evolutions and outcomes that range from asymptomatic to a mild or non-specific viral syndrome and to a severe and occasionally fatal disease characterized by hemorrhage and shock.

Herewith we report a Social/cultural factor in Bhutan that suggests that the males getting vector bites is probably higher than females. The Bhutanese men wear a long knee length gown, raised and fastened at the waist using the belt ‘kera’ similar to that used by the women but with less length. This difference in dress causes about 5% lower limbs more exposed then females and being lower limbs provides more opportunity to female Aedes mosquitoes to bite. Aedesaegypti predominantly feed on human blood and being day biter their process of probing to take blood to full satiation is often interrupted. Availability of exposed lower extremities of the body provides them full opportunity to ingest blood with less interruption.