In the past three months nine Bhutanese college students in Bangkok and India have been diagnosed with tuberculosis after they checked themselves at the national referral hospital in Thimphu. The latest case was that of a student from Bangkok diagnosed with the disease yesterday. According to doctors, all the cases, except for one, are thought to be contagious through sputum. Three of the students study in Bangalore, one in Shillong, two in Sikkim and three in Bangkok. All the students are also between the age group of 20 to 25. The cases were all detected between January and April 2008, with a spate of same city cases coming up. One of the relatives of a student from Bangkok said, "We have strong reason to believe that our relative contracted the disease in Bangkok from other Bhutanese students studying there.' The case profile 3 Bangkok 3 Bangalore 2 Sikkim 1 Shillong The symptoms: Cough for more than 3 weeks Prolonged fever Rapid weight loss The TB programme officer at the national referral hospital, Dr Pandur Tshering, said, "Our youth's lifestyle of late night parties, smoking, drinking, poor diet and even drugs and unsafe sex (HIV) make their immune system weak and thus vulnerable to TB.' Another major factor is that, with increasing globalization and students going out, more of them are exposed to foreign environments and also diseases. None of the nine students had TB when they left Bhutan. According to doctors, the deadliest strain of TB is the Kalimpong strain, because it is resistant to most drugs and difficult to treat. In fact, not too long ago, another student from there was diagnosed with such a strain, though luckily none of the present nine students have been found to have the virus. "TB in Bhutan and also across the world is more common among the economically active age group of 15-54 years, since they are more exposed to the outside world,' said Dr Pandur Tshering. In Bhutan, it has also been observed lately that, with more pressures on youth and less avenues to keep themselves occupied, many adopt lifestyles that leave them with weak immune systems, according to health workers. A relative of one of the victims said, "Health ministry officials should have at least alerted students to such possibilities and asked students going outside to take necessary precautions.' Students of other foreign countries are given multiple vaccinations and shots to guard against these possibilities, but the health ministry has not initiated any such programmes. Another relative said, "The health department screens people for diseases before they leave the country, but it would make more sense to screen them when they come back so that we can treat our sons and daughters before it's too late.' According to doctors, the health symptoms that can lead to TB are coughing for more then three weeks, rapid loss of weight and continuous fever. "If patients come to us at an early stage, they stand a very good chance of treatment, but the problem is for those patients who come late,' said Dr Pandur Tshering. Bhutan, as of 2007, had 1,008 cases of TB, compared to around 900 in 2006, which means a jump of around 100 detected cases. But officials say that estimated annual infections could be as high as 474. Another troubling data was that a survey done in 1991 showed that 1.5 percent of Bhutanese had TB bacteria in them, but that it only emerged for those that had weak immune systems. With nine cases in a short span of time, of which eight are infectious, the health department is yet to issue any notices or warnings to students, who may be going to the same cities. By Tenzing Lamsang