Are we ready to face re-emergence of vector borne disease scrub typhus ?

Debapriya Mukherjee *

The number of deaths on account of Scrub typhus in Indira Gandhi Medical college and Hospital has reached to 10. Many states in this season are being witnessed to the worst Scrub typhus outbreak. This vector born disease which was endemic in the past and was considered to be of less importance has again shown an upsurge in recent years.

The global reemergence of Scrub typhus has dealt a deadly blow to the public health professionals and medical fraternity alike surpassing even malaria and dengue by its sheer magnitude in terms of geographical expanse, morbidity and mortality in areas endemic for both.

This Vector borne disease has been known to mankind since antiquity. Scrub typhus, also known as bush typhus, is a mite-borne rickettsial zoonosis caused by the organism Orientia tsutsugamushi. It is the leading cause of treatable unidenti?ed febrile illnesses in Southeast Asia.

Humans occasionally become infected after being bitten by an infected chigger (the larval stage of a mite). Both rodents and mites are the natural reservoir hosts. A chigger (larvae of trvombiculid mite) borne disease caused by intracellular obligate bacterium Orientia tsutsugamushi has ?nally expanded its area of in?uence from the famous ‘tsutsugamushitriangle’ which covers more than 8 million km2 , from the Russian Far East in the north to Pakistan in the west, Australia in the south, and Japan in the east.

The earliest published record of Scrub typhus can be traced to the 3rd century A.D from the Ming Dynasty in China. It was in China in 313 AD, that symptoms associated with Scrub typhus were first described in Chinese “Material Medica”. During the same time, the vector of Scrub typhus was also mentioned in Chinese literature as red insects found along river banks referring probably to the chiggers of trombiculid mites.

However, the description of Scrub typhus in recent times is from Japan in the year 1899. The history of Scrub typhus is indebted to the Japanese and British researchers who did pioneering work prior to World War II on characterizing Scrub typhus and the epoch making discovery of etiological agent of Scrub typhus by Nagayo.

Scrub typhus, nevertheless, shot into prominence during World War II (WW II) af?icting millions in the China- Burma India corridor of military action. The impact of Scrub typhus on military was so enormous that commanders were forced to withdraw troops from the affected areas, changing the course of the war itself.

Scrub typhus, thereafter, came to be established as a disease of military signi?cance but by the end of WW II, it had lost its prominence and was nearly forgotten barring its mention in the medical textbooks as a disease of historical importance.

The changing paradigms of human behavior coupled with globalization, industrialization, climate change, urbanization, changing agricultural pattern, deforestation and expansion of humans into previously uninhabited areas has led to the resurgence of Scrub typhus and other rickettsial diseases globally.

The population explosion and increased urbanization has changed land use and land cover including huge garbage accumulation on the land that providing favorable environment for the chiggers of trombiculid mite. Urbanization without any attention to proper sanitation and solid waste management causes increase of rodent population, which are reservoirs of the infection. This also contributes to a rise in rat associated zoonoses, such as rickettsiosis.

Chiggers might indicate the connection between climate change and the incidence of Scrub typhus. Chiggers are mainly located in grassy ?elds, gardens, parks, forests, bush, and moist areas around lakes or rivers, and their distribution is in?uenced by the humidity, temperature, and sunshine. Scrub typhus struck back, albeit with renewed vigour, impacting areas with previously known endemicity as also impressing newer expanses.

Now, Scrub typhus has emerged as a leading cause of public health concern in known areas of endemicity. The disease is currently estimated to impact 1 billion populations globally with 1 million casualties. Today, regrettably, the world stands a mute witness to its increasing sphere of activity and the day is not far when Scrub typhus will likely emerge as a major global vector borne disease to reckon with.

Thereby it is imperative to appreciate necessity of due importance and efforts to control its expanses with reference to anthropogenic activities. In this context it is pertinent to mention the quotation of Hans Zinsser, Rats Lice and History 1934 , “Typhus is not dead.

It will live on for centuries and it will continue to break into the open whenever human stupidity and brutality give it a chance, as most likely they occasionally will”-. Man has indeed made brutal assaults on nature and transgressed into ecological niches of mites called the ‘mite islands’ to in?uence and amplify opportunities of enhanced man-vector contact.

One of the reasons postulated for the repeated outbreaks of Scrub typhus is the antigenic heterogeneity of Orientia species coupled with the fact that exposure to one strain does not confer long lasting heterologous immunity in exposed individuals leading to repeated episodes.

Increasing awareness and high index of suspicion in endemic areas has also contributed to greater reporting of outbreaks. It is astonishing that despite stupendous advances in epidemiology of Scrub typhus, we are still struggling to contain Scrub typhus and its associated morbidity & mortality. Scrub typhus has struck back, but are we ready to tackle the challenges posed by the reemergence of Scrub typhus?

During the months of August to November, there is growth of secondary scrub vegetation which is the habitat of tormiculid mites. During this period high index of suspicion, rapid diagnosis and early onset of appropriate therapy can considerably decrease the case fatality rate. The clinical spectrum varies from mild fever to multi-organ dysfunction.

It was considered as a lethal disease in the pre-antibiotic era and is militarily important, causing enormous losses during World War II and the Vietnam War. Early diagnosis and the timely use of antibiotics are quite important. The median untreatable mortality is 6%, with a range of 0%–70%..

India’s poor surveillance network possibly leads to huge under-reporting of cases. India’s response to these acute a public health emergency point to a health-care system is chronically underfunded, unregulated, and has inadequate infrastructure.

Successive governments have promised health reform but at the same time funding for many health ministry programs is not adequate. Despite some gains in health care, India only spends little over 1% of its gross domestic product on health, which is among the lowest in the world.

In 2011, a Lancet Series called for the implementation of a universal Indian health service. The recent debate arguing for greater dependence on the private sector for health care is deeply troubling and re?ects an ideological split within the government. Differences in laboratory diagnostic methods and test results have further aggravated the problem of under reporting in India.

Many laboratories in India do not have stringent quality control regulations to ensure the reliability of these tests as done in the WHO-approved laboratories under the global network of d laboratories program. Thereby all laboratories should strictly follow the CDC (Centre for Disease Control and Prevention) testing algorithm for diagnosis and reporting of Scrub typhus disease cases in India at specialized referral laboratories.

As an emerging and re-emerging disease with unspeci?c clinical manifestations, Scrub typhus has been neglected and often misdiagnosed. Of course, advances in diagnostics have made the detection of agents responsible for such diseases easier in the recent times. At present, no Scrub typhus vaccine is available. Deratization and mite control can stop the transmission fundamentally, but it is usually impossible.

Prevention strategies include avoiding unnecessary exposure, aggressive e?orts to eliminate chigger breeding areas by weeding. Also public awareness campaigns are needed with emphasis on good sanitation (both general and personal), use of protective clothing and insect repellents to help reduce disease transmission. Community participation in campaigning preventive measure is an emergent need.

Healthcare workers, including medical doctors, also need to be educated so that Scrub typhus is considered as a di?erential for all individuals presenting with acute febrile illness, even when the characteristic eschar is absent. All the above measures not only have the potential to reduce disease burden but have also been found to prevent morbidity and mortality.

Prospective long term studies are needed to further understand the disease dynamics, so that focussed interventions can be designed and implemented for Scrub typhus surveillance and control inIndia. Still emergent need is to improve disease surveillance at Scrub typhus risk areas that may prevent the growing threat of this infection spreading across the country. The number of incidences and their correlation to seasonal variability must be critically evaluated to support and guide health policies of the decision makers.

* Debapriya Mukherjee wrote this article for The Sangai Express
The writer is Former Senior Scientist Central Pollution Control Board from Kolkata and can be reached at dpmcpcb(AT)yahoo(DOT)com
This article was webcasted on December 26, 2019

* Comments posted by users in this discussion thread and other parts of this site are opinions of the individuals posting them (whose user ID is displayed alongside) and not the views of We strongly recommend that users exercise responsibility, sensitivity and caution over language while writing your opinions which will be seen and read by other users. Please read a complete Guideline on using comments on this website.

  • Chingda Satpi Engellei #4 :: eRang
  • 28th Imphal Book Fair #2 : Gallery
  • Aseismic Building Design
  • Loving Death :: Poem
  • The benefits of CAA
  • Go natural with home made scrub
  • Looking at the journey from 1972
  • The Great Security Circus
  • Hentak - Indigenous Food Festival #1 : Gallery
  • Tribute Rock Concert for (L) Hegin #1 : Gallery
  • Markila, Shanghman, Charoibi : eMing
  • AMWJU amends code of conduct- Jan 22 2020
  • Lalkansung - Natl Child Award for Achievement
  • Where Vultures Dare :: Poem
  • 'BJP Nagaland President got his facts wrong'
  • Decide within four weeks message from SC
  • The Statehood Day
  • Landscape of Purul, Senapati #2 : Gallery
  • Naga Peace Process, Far from being close
  • Of bibliophile & Imphal Book Fair 2020
  • Constitutional protections to specific groups #2
  • Marketing & Sales at R-Square Design
  • Driver & Director's Assistant @ R-Square
  • Marketing & Research Officer @ Amethyst
  • Heart Camp at IGAR South, Mantripukhri
  • Naga Peace Process :: News Timeline
  • Pragjyoti International Dance Festival
  • Mentality of those who man Khudengthabi
  • When you fail to control the L & O ..
  • Gaan-Ngai at Kakhulong #1 : Gallery
  • Children Adventure Sports Camp #2 : Gallery
  • Adventure Tourism in Manipur
  • Special Police Unit for NE in Delhi
  • Niagara Falls with Devaz
  • Project Coordinator @ MaolKeki Foundation
  • Reducing air pollution : Impact & prevention
  • Right time for Assam Rifles to Go Back
  • Inner Line Permit (ILP) Demand : Timeline
  • Interesting pact between KNO & NNPGs
  • Nation & Unintegrated part now bridged
  • Conservation initiatives of Hornbills #1
  • Day 3 : Sangai Fest #4 : Gallery
  • Reminiscence of legendary aerobiologist
  • A get-together to banish the boredom
  • Hear us oh God :: Poem
  • Resolutions on Naga Political Issue & CAA
  • Stop land allotment of Yaithibi Loukol
  • Wildfire at lower ridge of Shirui Kashong
  • Statehood Women's Polo : Gallery
  • Adversity of Diversity: Chow-Momo Indian
  • Harvard team with CM : Gallery
  • Workshop: Typesetting with Latex @ MU
  • The great cosmic discovery - VII
  • NPF opposed Citizenship Amendment Act
  • Of the highway brave hearts
  • 28th Imphal Book Fair #1 : Gallery
  • Winter Relief Program @Patsoi: Gallery
  • Who are Indigenous People of Manipur #7
  • 2019: Ministry of Development (DoNER)
  • Consultative meeting on Meetei ST demand
  • Beauty benefits of meditation
  • Environment conservation & mankind..
  • Of our Responsibility and our Rights
  • Imoinu Erat Thouni #2: Gallery
  • Gaan-Ngai @Chingkham Kabui Khul: Gallery
  • Condolence on demise of Mahima Khan
  • Coping with anxiety before laboratory test
  • The lonely Moon :: Poem
  • Natl Conference on chemicals sciences
  • Constitutional protections to specific groups #1
  • KASHISH, Indian LGBTQ short films
  • Drugs & manufacturing: Who are the kingpins?
  • Indigenous People must defend environment
  • Cultural @ Shirui Lily Fest #4 : Gallery
  • Children Adventure Sports Camp #1 : Gallery
  • Day 3 : Sangai Fest #3 : Gallery
  • The Killing Fields 2013-20 : News Timeline
  • Khangminashi VI, talk series : Food research
  • Can people of NE blame Centre alone for CAA
  • The City of Darkness :: Poem
  • Time for Nagas to build the future: Rio
  • Checking the statements of UG outfits
  • Restoring to the status of People's CM
  • Ibudhou Thangjing, Moirang :: 360 ø View
  • Phamsak collaboration in indigenous ambience
  • Why this relaxation of 12 yrs unless..
  • Being a chow-momo Indian; the fun side!
  • Monika Ingudam - Amb for India Volunteers
  • Petition to CM to dispose contract teachers
  • Call to curb favouritism and nepotism
  • For a better world - to our world leaders
  • Gaan-Ngai @ Ramji Kabui Khul : Gallery
  • Niti Aayog must stop plan to privatise health
  • For the future :: Poem
  • Career in Fashion Communication
  • Jobs at LMP Technology, Canchipur
  • Too many festivals in a year observation
  • What ails Chief Minister gi Haksel gi Tengbang
  • Thong Nambonbi broke apart: Gallery
  • Who are Indigenous People of Manipur #6
  • Fit India Khelo India
  • The Car Washed Shampoo :: Poem
  • Economic development : Special focus on hills
  • Climate change : Biggest challenge in 2020s
  • MAYA trainer at MAAC Imphal center
  • How about the Salt Lake Manipur Bhavan?
  • Fashion Show @ Sangai Fest #1: Gallery
  • Youth and Nation
  • Lyrics of Departing Year :: Poem
  • Forgotten elixir for youths of Manipur
  • Banknotes for sale
  • ADBU - 'Engaged University of the Year'
  • Traffic chaos - a serious problem
  • 'Nongju Ahing' :: eRang Classic Photos
  • Day 1 : Sangai Fest #5 : Gallery
  • City lights :: Poem
  • How China impacts security dynamics in NE
  • Rhythms & Aromas of NE at Ukhrul
  • Lipstick mistakes to avoid
  • Giving a fresh push to the Lim debate?
  • Thong Nambonbi is a part of our history
  • Shumang Leela Ningtham Kumhei: Gallery
  • Death Anniv- Maharaj Gambhir Singh : Gallery
  • Go develop the Hills : A live case study
  • A canal to augment Imphal City, a must !
  • The present health of Loktak Lake
  • Meiraba- 3rd in Badminton World Federation
  • After effects of CAA in North East
  • Film Policy - awaiting action
  • Arambai Langba @Kangjeibung : Gallery
  • JNIMS - Untold story #2
  • CAA is a threat to indigenous communities
  • Ukhrul auditions for Rhythms & Aromas of NE
  • A Wintry Number :: Poem
  • Career in fashion industry
  • Suspension Order issued by NPF to Kenye
  • Web Developer / Trainee at Lamjing IT
  • Cabinet approves NE Gas Pipeline Grid
  • Claiming hands in attack at JNU
  • The changing concept of patriotism
  • IM on integration, Pan Naga Hoho & others
  • Imoinu Erat Thouni #1: Gallery
  • Gaan-Ngai :: e-Pao Flash Presentation
  • Gaan-Ngai :: Read all about it
  • Asylum for select migrants.. madness ?
  • Who are Indigenous People of Manipur #5
  • Irom Roshan to exhibit humanoid robot IVALA
  • NPF Statement on CAA 2019
  • Time to focus on examinations
  • The taste of Indian democracy
  • Culturals @ Mera Houchongba #3: Gallery
  • Press Club Foundation Day: Gallery
  • A Hymn for Goddess Emoinu
  • Post-mortem of New Year Celebration
  • Shillong audition for Rhythm & Aromas of NE
  • Army Arrived at Lunch
  • Cocktail of CAB, CAA, NRC & NPR
  • A treatise on mind #3
  • Menamparampil for Journalism Award
  • Govt committed to protect indigenous people
  • Cabinet increase pension for retired journalist
  • Hiyangthau :: Funga Wari
  • Official Release of AMAND Calendar 2020
  • Happening and good cheer as career
  • Voices of the Stars :: Poem
  • Yaikhomba: Selected National Bravery Award
  • War against the English language
  • BJP : In Delhi & Manipur: Twain does not meet
  • Licypriya- Top 100 Child Prodigy: Gallery
  • A Critique of the Manipur ILP Guidelines
  • Licypriya- 100 Child Prodigies : Report
  • Critique of ILP Guidelines (Meiteilon)
  • Architectural Designer at R-Square
  • AutoCad Drafsman at R-Square
  • Crops production & Award for Manipur !
  • New Year picnic @Singda Dam : Gallery
  • Kairembikhok Women opted carpentry
  • RIST Talk -42 @MU : Mimicking nature
  • Obsessive Compulsive Disorder
  • Project Engineer at R-Square
  • Site Manager at R-Square
  • Research Officer at Amethyst
  • Jobs @ Birla Emporiums, Khurai
  • Assam looking at bygone years
  • Krishi Karman Award for Manipur !
  • Khusbu Sorokhaibam : Glass Painting
  • Who are Indigenous People of Manipur #4
  • CC Meet 2019 : Fixture (Semis & Final)
  • JNIMS - Untold story #1
  • About Failed 'Real Madrid' & Climate Change!
  • Manipur : Krishi Karman Award for foodgrain
  • Year end review: Department of Atomic Energy
  • Disturbed area status & improved law & order
  • The choice is yours Mr. Chief Minister
  • Dec 30 : Sangai Fest #1 : Gallery
  • Marriage rituals of Tais #2
  • Recovering compensation from CAA agitators
  • In The Name of Democracy
  • A treatise on mind #2
  • Nightingales in Winter :: Poem
  • Social Service at Ibudhou Thangjing campus
  • Manipur start issue of ILP permits
  • 386 arrested in 282 drug related cases : 2019
  • NIA files chargesheet in AR ambush case
  • 'Marketing' on New Year 2020 eve: Gallery
  • Featured Front Page Photo 2019 #6: Gallery
  • Meetei Today launches new website
  • Manipur : As I grew up in #3
  • Bye - Bye 2019 :: Poem
  • Stands in solidarity with the Workers
  • Peace or Pandora's Box in 2020 ?
  • X-Mas @Ukhrul, @Kpi #2 : Gallery
  • January Calendar for Year 2020 : Tools
  • Normal age forgetfulness vs Dementia
  • Who was afraid of NK Sanajaoba ?
  • Bidding farewell with a new hope
  • Hogenakkal - India's Niagara
  • Degrading environment vs activities
  • State of economy in the dark times
  • Understanding the lives of Trans community
  • New species: Trichodesma Kumareum
  • The Spear is born for the Zulu
  • Water Pollution: Causes & Effects
  • Year End Review 2019, Dept of Youth Affairs
  • Bridging disconnect & delving deeper
  • X-Mas @Ukhrul, @Kpi #1 : Gallery
  • Day 3 : Sangai Fest #2 : Gallery
  • State of our state
  • Culturals @ Mera Houchongba #2: Gallery
  • Destination NE @ Vanarasi #5: Gallery
  • Mister Manipur 2019 #3 : Gallery
  • Day 1 : Sangai Fest #4 : Gallery
  • Piulong Valley, Tamenglong #1: Gallery
  • Aerial- Imp to Tamenglong: Gallery
  • Eyek Tamba :: Learn Manipuri script
  • Nupi Lan Ningsing Lamjel #2: Gallery
  • Nupi Lan Day (State): Gallery
  • Brahmacharimayum Mahendra : Silpbhusan
  • Tolloi, Ukhrul :: 360 Panorama View