Risk Factors for Acquiring Scrub Typhus among Children in Deoria and Gorakhpur Districts, Uttar Pradesh, India, 2017

Thangaraj, Jeromie Wesley Vivian; Ravi, Vasanthapuram; Machado, Leonard; Arunkumar, G.; Sodha, Samir V.; Zaman, Kamran; Bhatnagar, Tarun; Hameed, Shafeeq K Shahul; Kumar, Arun; Abdulmajeed, Jazeel; Velayudhan, Anoop; Deoshatwar, Avinash; Desai, Anita; Kumar, Kaushlendra; Gupta, Nivedita; Laserson, Kayla F.; Murhekar, Manoj

doi:10.3201/eid2412.180695

Cited by 20 publications

(22 citation statements)

References 15 publications

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“…In addition, rodents gets attracted to the food kept for these domestic animals, which, in turn, become host for the mites 6 21 22 . Practice of open-air defecation is identified as an important predictor of both seroprevalent and seroincident O. tsutsugamushi infections during peak period 23 . People go out in fields, bushes, forests, river banks, or other open spaces for defecation and are exposed to vector bites.…”

Section: Discussionmentioning

confidence: 99%

Seroprevalence & seroincidence of Orientia tsutsugamushi infection in Gorakhpur, Uttar Pradesh, India: A community-based serosurvey during lean (April-May) & epidemic (October-November) periods for acute encephalitis syndrome

et al. 2020

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Background & objectives: In India, acute encephalitis syndrome (AES) cases are frequently reported from Gorakhpur district in Uttar Pradesh. Scrub typhus is one of the predominant aetiological agents for these cases. In order to delineate the extent of the background of scrub typhus seroprevalence and the associated risk factors at community level, serosurveys during both lean and epidemic periods (phase 1 and phase 2, respectively) of AES outbreaks were conducted in this region. Methods: Two community-based serosurveys were conducted during lean (April-May 2016) and epidemic AES (October-November 2016) periods. A total of 1085 and 906 individuals were enrolled during lean and epidemic AES periods, respectively, from different villages reporting recent AES cases. Scrub typhus-seronegative individuals (n=254) during the lean period were tested again during the epidemic period to estimate the incidence of scrub typhus. Results: The seroprevalence of Orientia tsutsugamushi during AES epidemic period [immunoglobulin (Ig) IgG: 70.8%, IgM: 4.4%] was high as compared to that of lean AES period (IgG: 50.6%, P <0.001; IgM: 3.4%). The factors independently associated with O. tsutsugamushi positivity during lean AES period were female gender, illiteracy, not wearing footwear, not taking bath after work whereas increasing age, close contact with animals, source of drinking water and open-air defecation emerged as additional risk factors during the epidemic AES season. IgM positivity was significantly higher among febrile individuals compared to those without fever (7.7 vs. 3.5%, P =0.006). The seroincidence for O. tsutsugamushi was 19.7 per cent, and the subclinical infection rate was 54 per cent. Interpretation & conclusions: The community-based surveys identified endemicity of O. tsutsugamushi and the associated risk factors in Gorakhpur region. The findings will be helpful for planning appropriate interventional strategies to control scrub typhus.

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Section: Discussionmentioning

confidence: 99%

Seroprevalence & seroincidence of Orientia tsutsugamushi infection in Gorakhpur, Uttar Pradesh, India: A community-based serosurvey during lean (April-May) & epidemic (October-November) periods for acute encephalitis syndrome

et al. 2020

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“…Poor response with doxycycline in some countries suggested the potential emergence of resistant strains [25]. Early administration of doxycycline/azithromycin was found to reduce the progression to AES in India [3], treatment delay has to be avoided.…”

Section: Discussionmentioning

confidence: 99%

“…However, there have been recent reports of scrub typhus from Africa, France, the Middle East, and South America suggesting the disease is no longer restricted to this triangle [2]. Scrub typhus is frequently reported from many Asian countries and is endemic in Nepal's neighboring countries including India (Sub-Himalayan belt) and Bhutan, where it is considered an emerging infectious diseases [3][4][5][6]. In Bhutan, one in six undifferentiated febrile patients had rickettsial infections, with scrub typhus being the most common [6].…”

Section: Introductionmentioning

confidence: 99%

“…established nature of scrub typhus outbreaks in Nepal through evidences of the causative agent O. tsutsugamushi in human (patients), animals (rodents) and vector/ reservoir hosts (chigger mites) during the recent fatal outbreaks. Despite the frequent reports of outbreaks from neighbouring countries, particularly India and others[3][4][5][6][17][18][19][20], scrub typhus remained silent in Nepal for decades after its first indication in 1981[7].…”

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confidence: 99%

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Confirmation of local transmission of Orientia tsutsugamushi during scrub typhus outbreaks in Nepal

Dhimal

Dumre

Sharma³

et al. 2019

Preprint

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Background:Scrub typhus is a severely ignored tropical disease and a leading cause of undifferentiated febrile illness worldwide caused by infection of an obligate intracellular bacteria Orientia tsutsugamushi. It has been rapidly expanding 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 scrub typhus and its causative agents in human, rodent and chigger mites to better 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 country-wide data from 2015 to 2017 was made available from the government database to analyse the disease distribution using geographical mapping. Results:During 2015-2017, 1,239 scrub typhus cases were confirmed with the largest outbreak occurring in 2016 with 831 (67.1%) cases. The remainder 267 cases were reported in 2017.The case fatality rate was 5.7% in 2015 and declined to 1.1% in 2017. Nationwide outbreak of scrub typhus was identified as the cases were found from 52 of the 75 districts of Nepal. A seasonal trend was observed with a peak during August and September (p = 0.01). In addition to the human cases, the presence of O. tsutsugamushi was also confirmed in rodents and chigger mites from the outbreak areas of southern Nepal. Conclusion:The detection of O. tsutsugamushi in human, rodent, and chigger mites from outbreak locations and wide-spread reports of scrub typhus throughout the country over two 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 outbreaks detection, and immediate response actions including treatment and preventive measures. Author SummaryScrub typhus is a disease caused by a bacteria called Orientia tsutsugamushi and transmitted to people through bites of infected chiggers (larval mites). After the 2015 Gorkha earthquake in Nepal, a sudden upsurge in scrub typhus cases was reported with repeated outbreaks from different parts of the country. This study has documted epidemiology of scrub typhus and its causative agents in human, rodent and chigger mites confimring the local transmission O.tsutsugamushi with a firmly established ecology in Nepal. The local transmission of the diseases from most parts of the country demands strengthening for systematic surveillance, early outbreaks detection, and immediate response actions including treatment and preventive measures.

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“…Presence of vegetation or bushes near the house is a risk factor for scrub typhus. In Gorakhpur, children who had recent exposure to the outdoor environment (for defecation, playing or visiting agricultural fields), or engaged in storing firewood indoors, and handling fodder for cattle were found to be at a higher risk for acquiring scrub typhus [12]. Strategies for prevention of scrub typhus should therefore include providing sanitary toilets and focus on changing behaviors through policy initiatives like Swach Bharat Abhiyan.…”

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confidence: 99%

Presumptive Treatment of Acute Febrile Illness for Preventing Acute Encephalitis Syndrome: Does It Work?

Aneja

Joshi

2020

Indian Pediatr

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Risk Factors for Acquiring Scrub Typhus among Children in Deoria and Gorakhpur Districts, Uttar Pradesh, India, 2017

Cited by 20 publications

References 15 publications

Seroprevalence & seroincidence of Orientia tsutsugamushi infection in Gorakhpur, Uttar Pradesh, India: A community-based serosurvey during lean (April-May) & epidemic (October-November) periods for acute encephalitis syndrome

Seroprevalence & seroincidence of Orientia tsutsugamushi infection in Gorakhpur, Uttar Pradesh, India: A community-based serosurvey during lean (April-May) & epidemic (October-November) periods for acute encephalitis syndrome

Confirmation of local transmission of Orientia tsutsugamushi during scrub typhus outbreaks in Nepal

Presumptive Treatment of Acute Febrile Illness for Preventing Acute Encephalitis Syndrome: Does It Work?

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