Scrub typhus: A serious public health issue in Nepal

Abstract

The agro-climatic conditions, socio-economic situation, poor sanitation, low hygiene and health standards in Nepal are major contributing factors to the emergence of scrub typhus in Nepal. These outbreaks, along with poor diagnostic facilities, can lead to severe economic losses in a resource-limited country like Nepal. Diseases like avian influenza, leptospirosis, brucellosis, tuberculosis and rabies, that cause heavy socio-economic burden, have received huge attention of Government of Nepal and hence are among the top ten priority diseases. However, until now, scrub typhus is not considered a priority disease in Nepal, despite having severe outbreaks time to time. In order to diagnose and treat scrub typhus infection, low budget diagnostic tests such as Weil Felix are less efficient and poor in screening, and highly advanced & efficient tests are less likely to be available and are expensive. Nepal needs to explore appropriate and applicable test settings in primary health centers and referral laboratories in the country. Moreover, focus should be made on effective surveillance programs and public awareness campaigns, mice/rat control strategies, and improving sanitation, public health and hygiene measures for the people at most risk. In addition, health workers and professionals should be trained on early case detection, personal protection, proactive rodent control strategies, habitat destruction and good sanitation and hygiene practices.

Scrub Typhus and Molecular Characterization of Orientia tsutsugamushi from Central Nepal

“…Scrub typhus is emerging as a major public health problem in Nepal with reports of its occurrence from several widely reported geographic areas [ 12 , 13 ]. Despite reports of serological evidence of scrub typhus [ 10 ], Nepalese molecular surveys have been largely limited to studies of chiggers mite samples and samples from rodents [ 12 ].…”

Outbreak prone communicable diseases of public health importance in the northern districts of West Bengal – Current status & the way forward

“…Among India, Bangladesh, Nepal and Bhutan, only Bhutan has declared ST as a notifiable disease so far. Community and hospital based serosurveillance reports are available from these four countries providing evidence of endemicity of ST 8 10 42 43 44 . Similar reports are also available for Assam and Bihar 45 46 .…”

“…Similar hospital based sero-surveillance studies for scrub typhus showed seropositivity against O. tsutsugamushi viz . Bangladesh (16.6%), Nepal (52.6%), Bhutan (22.6%), and in the Indian States of Assam (20.3%), Bihar (25%) and West Bengal (10.5%) (at NBMCH) among AFIs 8 10 44 45 46 49 .…”

“…With its innate geographical vulnerabilities, the State of West Bengal is favourable for outbreaks of a large number of infectious diseases. The northern districts of West Bengal ( Figure ) mainly Alipurduar, Jalpaiguri, Cooch Behar and Darjeeling, are heavily forested, rich in wild life biodiversity and share international borders with countries like Bangladesh, Bhutan and Nepal and inter-State borders with Indian States like Bihar, Assam and Sikkim (which shares the international border with China and Bhutan) which are also well-known endemic areas for many outbreak prone communicable diseases 3 4 5 6 7 8 9 10 11 . Jalpaiguri and Alipurduar districts of West Bengal are endemic for malaria with reports of outbreaks, deaths and drug resistant Plasmodium falciparum cases 12 13 14 .…”

Seroprevalence of Scrub Typhus in Patients Attending Dhulikhel Hospital, Kavre

“…13,14 The epidemiological data related to Scrub typhus is minimum as it is not considered a priority disease in Nepal compared to avian influenza, rabies, and other zoonotic diseases. 15 Nevertheless, EDCD (Epidemiology and Disease Control Division) of Nepal has developed the guidelines for prevention and control of scrub typhus but these guidelines have rarely been implemented. 16 In 2021, various districts in Nepal saw rise in Scrub Typhus cases with 28 reported cases in Bajura District and 22 cases in Baitadi until mid of September.…”