Meghnath Dhimal1, Shyam Prakash Dumre2,3, Guna Nidhi Sharma4,5, Pratik Khanal6,7, Kamal Ranabhat7,8, Lalan Prasad Shah8, Bibek Kumar Lal4, Runa Jha9, Bishnu Prasad Upadhyaya9, Bhim Acharya4, Sanjaya Kumar Shrestha10, Silas A Davidson11, Piyada Charoensinphon11, Khem B Karki6,7. 1. Nepal Health Research Council (NHRC), Ramshah Path, Kathmandu, Nepal. meghdhimal2@gmail.com. 2. Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal. 3. Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan. 4. Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal. 5. Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal. 6. Nepal Health Research Council (NHRC), Ramshah Path, Kathmandu, Nepal. 7. Institute of Medicine, Tribhuvan University, Kathmandu, Nepal. 8. Department of Health Services, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal. 9. National Public Health Laboratory, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal. 10. Walter Reed/AFRIMS Research Unit Nepal (WARUN), Kathmandu, Nepal. 11. Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand.
Abstract
BACKGROUND: Scrub typhus is a largely ignored tropical disease and a leading cause of undifferentiated febrile illness in the areas of tsutsugamushi triangle caused by Orientia tsutsugamushi. It is frequently diagnosed in South Asian countries, although clear epidemiological information is not available from Nepal. After the 2015 earthquake in Nepal, a sudden upsurge in scrub typhus cases was reported. The objective of this study was to investigate epidemiology of scrub typhus and its causative agents in humans, animals, and chigger mites to understand the ongoing transmission ecology. METHODS: Scrub typhus cases with confirmed diagnosis throughout the country were included in the analysis. Studies were concentrated in the Chitwan district, the site of a major outbreak in 2016. Additional nation-wide data from 2015 to 2017 available from the government database included to analyse the disease distribution by geographical mapping. RESULTS: From 2015 to 2017, 1239 scrub typhus cases were confirmed with the largest outbreak occurring in 2016 with 831 (67.1%) cases. The case fatality rate was 5.7% in 2015 which declined to 1.1% in 2017. A nationwide outbreak of scrub typhus was declared as the cases were detected in 52 out of the 75 districts of Nepal. Seasonal trend was observed with a peak during August and September. In addition to the human cases, the presence of O. tsutsugamushi was also confirmed in animals (rodents) and chigger mites (Leptotrombidium imphalum) from the outbreak areas of southern Nepal. CONCLUSION: The detection of O. tsutsugamushi in humans, animals, and chigger mites from outbreak locations and wide-spread reports of scrub typhus throughout the country consecutively for 3 years confirms the ongoing transmission of O. tsutsugamushi with a firmly established ecology in Nepal. The country's health system needs to be strengthened for systematic surveillance, early outbreak detection, and immediate actions including treatment and preventive measures.
BACKGROUND: Scrub typhus is a largely ignored tropical disease and a leading cause of undifferentiated febrile illness in the areas of tsutsugamushi triangle caused by Orientia tsutsugamushi. It is frequently diagnosed in South Asian countries, although clear epidemiological information is not available from Nepal. After the 2015 earthquake in Nepal, a sudden upsurge in scrub typhus cases was reported. The objective of this study was to investigate epidemiology of scrub typhus and its causative agents in humans, animals, and chigger mites to understand the ongoing transmission ecology. METHODS: Scrub typhus cases with confirmed diagnosis throughout the country were included in the analysis. Studies were concentrated in the Chitwan district, the site of a major outbreak in 2016. Additional nation-wide data from 2015 to 2017 available from the government database included to analyse the disease distribution by geographical mapping. RESULTS: From 2015 to 2017, 1239 scrub typhus cases were confirmed with the largest outbreak occurring in 2016 with 831 (67.1%) cases. The case fatality rate was 5.7% in 2015 which declined to 1.1% in 2017. A nationwide outbreak of scrub typhus was declared as the cases were detected in 52 out of the 75 districts of Nepal. Seasonal trend was observed with a peak during August and September. In addition to the human cases, the presence of O. tsutsugamushi was also confirmed in animals (rodents) and chigger mites (Leptotrombidium imphalum) from the outbreak areas of southern Nepal. CONCLUSION: The detection of O. tsutsugamushi in humans, animals, and chigger mites from outbreak locations and wide-spread reports of scrub typhus throughout the country consecutively for 3 years confirms the ongoing transmission of O. tsutsugamushi with a firmly established ecology in Nepal. The country's health system needs to be strengthened for systematic surveillance, early outbreak detection, and immediate actions including treatment and preventive measures.
Entities:
Keywords:
Epidemiology of scrub typhus; Local transmission; Nepal; Orientia tsutsugamushi; Outbreak; Rickettsial infection; Scrub typhus
Authors: Mark D Zimmerman; David R Murdoch; Patrick J Rozmajzl; Buddha Basnyat; Christopher W Woods; Allen L Richards; Ram Hari Belbase; David A Hammer; Trevor P Anderson; L Barth Reller Journal: Emerg Infect Dis Date: 2008-10 Impact factor: 6.883