An outbreak of scrub typhus in Bishnupur district of Manipur, India, 2007.

Seasonal outbreaks of febrile illness with eschar have been occurring in Bishnupur district of Manipur since 2001. The aetiology of these outbreaks was unknown. We investigated a similar outbreak in 2007 in order to confirm the aetiology and identify its risk factors. We identified 38 patients who met the case definition (attack rate: 3.4/1000), including two deaths (case fatality ratio = 5.3%). Half of the female patients had eschar on the perineal area. The clinical picture and Weil-Felix positivity suggested that the outbreak was due to scrub typhus. The disease was more common among individuals who defecated or urinated in the jungle or bushy areas from a squatting position. We recommended educating the community about the common symptoms of the disease, encouraging them to seek early treatment from public health facilities and suggested that they be taught to avoid defecating/urinating from a squatting position in the jungle.