The Epidemiology and Disease Control Division has alerted health workers serving at the health desks set up at international border crossings and other places about the risk of looming malaria and dengue outbreaks.

Officials say that thousands of migrant workers return home from India during Dashain and Tihar festivals, and some of them could also import malaria unknowingly. The 15-day Dashain, Nepal’s biggest festival, began Monday.

Similarly, as the post-monsoon season, which is a peak dengue season, is set to start, the risk of dengue increases.

“We are already struggling to contain the spread of malaria and dengue,” said Dr Chandra Bhal Jha, director at the division. “Many Nepalis work as migrant workers in India and some of them could have been infected with malaria. As malaria spreading mosquitoes are already present in the country, the risk of outbreak is high.”

Malaria is caused by Plasmodium parasites. Infected female Anopheles mosquitoes carry these deadly parasites, according to the World Health Organisation.

Nepal has already missed its malaria elimination deadline multiple times, and it has now been postponed to 2030.

Officials say new cases of both indigenous and imported malaria continue to rise each year, and with both existing and emerging challenges, experts are sceptical about the country’s ability to eliminate the disease even within the next five years. Open borders, global movements and mosquitoes moving to higher altitudes due to climate change pose challenges to the elimination goal, they said.

This year, around a dozen cases of indigenous cases of malaria infection have been reported.

Indigenous malaria cases are locally transmitted as infected persons do not have a history of travel to malaria-affected countries.

Meanwhile imported cases are those in people with a history of travel to malaria-hit areas or countries.

To eliminate malaria, the country should bring down indigenous cases or local transmission of the disease to zero, achieve zero deaths from 2023, and sustain zero cases for three consecutive years, according to the World Health Organisation.

Of the total imported cases, over 80 percent have come from India. Due to proximity, and an open and porous border between Nepal and India and unregulated travel of people of both countries, it is impossible to eliminate malaria here in Nepal, until the disease gets eliminated in India, said experts.

The problem is not only that Nepali migrant workers get infected in various cities of India, but also Nepali peacekeepers serving in various African nations, who bring the disease home, where it later becomes indigenous due to transmission from local vectors.

This year, three deaths and around 5,000 cases of dengue infection have been reported in Nepal since January. The disease has spread to 74 of the country’s 77 districts.

Dengue is a viral disease transmitted by female Aedes aegypti and Aedes albopictus mosquitoes. According to the World Health Organisation, the same vector also transmits chikungunya, yellow fever, and the Zika virus.

Dengue mosquitoes breed in clean water and bite during daytime. Uncovered water tanks and discarded objects such as plastic cups and bottles can serve as breeding grounds.

In 2024, 15 people died, and 41,865 others were infected as the virus spread to 76 districts. In 2023, 88 persons died and more than 54,000 were infected by the virus, which had spread to all 77 districts. At the time, hospitals in Kathmandu Valley were overwhelmed with dengue patients, and pharmacies had run out of paracetamol, the most widely used medicine to treat fever.

Experts say reported cases may represent only a small fraction of the true scale of infection, as around 90 percent of the infected people are asymptomatic, and many deaths and infections often go unreported.

Symptoms of the disease include mild to high fever, severe muscle pain, rashes, severe headache and pain in the eyes, among other things. Doctors advise those with these symptoms to seek immediate treatment. While there is no specific cure for the disease, early detection and access to proper medical care can lower fatalities.

Many people infected with dengue show mild symptoms, which do not need any treatment or can be managed with paracetamol at home.

Since dengue became endemic in Nepal years ago, meaning people get infected throughout the year, health officials no longer classify it as an outbreak of a deadly virus.

In the worst-case scenario, over 60,000 people could get infected with the dengue virus in the next three months, according to a projection prepared by the Epidemiology and Disease Control Division.

Doctors say that, along with launching a search-and-destroy drive on a regular basis, authorities should also focus on strengthening the capacity of health facilities to prevent them from being overwhelmed in the event of a possible massive outbreak, experts say.

Nepal reported its first dengue case in a foreigner in 2004 in Chitwan district. Since then, an increasing number of dengue infections, including major outbreaks, have been reported from many districts.

The World Health Organisation says there is no specific cure for severe dengue, but early detection and access to proper medical care can save lives.