Re-Emergence of Scrub Typhus as a Public Health Problem in India: Its Spatial and Temporal Distribution Based on Analysis of 15-Year Data of the National Integrated Disease Surveillance Programme
Abstract
Introduction: The Integrated Disease Surveillance Programme (IDSP) in India monitors trends in epidemic-prone diseases for an early response to outbreaks. Being the only authentic programmatic source of national scrub typhus data, we analysed the burden of this disease and assessed the sufficiency of the IDSP system to control the disease.
Method: In this descriptive study, we analysed all 7564 IDSP weekly reports since its inception in 2009 until 2023, and assessed disease burden, mortality, clinical features, diagnostic modalities, treatment protocols, and prevention and control measures undertaken.
Results: Among the 756 IDSP weekly outbreak reports, 127 scrub typhus outbreaks were reported with 3751 cases and 93 deaths (case fatality rate: 2.48%). Thirty-two reports were excluded from the analysis that listed scrub typhus under outbreaks of other diseases or as co-illnesses with unclear diagnoses. The highest number of outbreaks, cases, and deaths were reported in the north-eastern zone of India, but most deaths were in Rajasthan state in the western zone. The outbreaks occurred year-round but mostly in the wet season from July to September.
Conclusions: The IDSP data represents only a partial picture of the true burden of scrub typhus in India. It reported limited or no information on vectors, antigenic strains of Orientia tsutsugamushi, risk factors, clinical presentations, diagnostic tests, treatment, and preventive and control measures undertaken by health services. This warrants improving the performance and functionality of the system.
How to cite this article:
Tilak R, Anand V, Gupte M D, Devarakonda R, Yadav R S. Re-Emergence of Scrub Typhus as a Public Health Problem in India: Its Spatial and Temporal Distribution Based on Analysis of 15-Year Data of the National Integrated Disease Surveillance Programme. J Commun Dis. 2024;56(2):70-93.
DOI: https://doi.org/10.24321/0019.5138.202440
References
Gaba S, Gupta M, Gaba R, Lehl SS. Scrub typhus: an update. Curr Trop Med Rep. 2021;8(2):133-40. [Google
Scholar]
Tilak R, Kunte R. Scrub typhus strikes back: are we ready? Med J Armed Forces India. 2019;75(1):8-17.
[PubMed] [Google Scholar]
Xu G, Walker DH, Jupiter D, Melby PC, Arcari CM. A review of the global epidemiology of scrub typhus. PLoS Negl Trop Dis. 2017;11(11):e0006062. [PubMed] [Google Scholar]
Devasagayam E, Dayanand D, Kundu D, Kamath MS, Kirubakaran R, Varghese GM. The burden of scrub typhus in India: a systematic review. PLoS Negl Trop Dis. 2021;15(7):e0009619. [PubMed] [Google Scholar]
Daryl JK, Fuerst PA, Ching WM, Richards AL. Scrub typhus: the geographic distribution of phenotypic and
genotypic variants of Orientia tsutsugamushi. Clin Infect Dis. 2009;48(3):S203-30. [PubMed] [Google Scholar]
Li W, Huang L, Zhang W. Scrub typhus with multi-organ dysfunction syndrome and immune thrombocytopenia: a case report and review of the literature. J Med Case Rep. 2019;13(1):358. [PubMed] [Google Scholar]
Chakraborty S, Sarma N. Scrub typhus: an emerging threat. Indian J Dermatol. 2017;62(5):478-85. [PubMed] [Google Scholar]
World Health Organization [Internet]. WHO recommended surveillance standards, 2nd ed. Geneva: World Health Organization; 1999 [cited 2024 May 28]. Available from: https://apps.who.int/iris/ handle/10665/65517
Taylor AJ, Paris DH, Newton PN. A systematic review of mortality from untreated scrub typhus (Orientia
tsutsugamushi). PLoS Negl Trop Dis. 2015;9(8):e0003971. [PubMed] [Google Scholar]
Integrated Disease Surveillance Programme, National Centre for Disease Control, India [Internet]. Ministry of Health & Family Welfare, Government of India; [cited 2024 May 28]. Available from: https://idsp.nic.in/ index1.php?lang=1&level=1&sublinkid=5768&lid=3697
Dass R, Deka NM, Duwarah SG, Barman H, Hoque R, Mili D, Barthakur D. Characteristics of pediatric scrub typhus during an outbreak in the north eastern region of India: peculiarities in clinical presentation, laboratory findings and complications. Indian J Pediatr. 2011;78(11):1365- 70. [PubMed] [Google Scholar]
Saifudheen K, Kumar KG, Jose J, Veena V, Gafoor VA. First case of scrub typhus with meningoencephalitis from Kerala: an emerging infectious threat. Ann Indian Acad Neurol. 2012;15(2):141-4. [PubMed] [Google Scholar]
Sivarajan S, Shivalli S, Bhuyan D, Mawlong M, Barman R. Clinical and paraclinical profile, and predictors of outcome in 90 cases of scrub typhus, Meghalaya, India. Infect Dis Poverty. 2016;5(1):91. [PubMed] [Google Scholar]
Mahajan SK, Raina R, Singh B, Singh DV, Kanga A, Sharma A, Kaushal SS. Pattern of clinical presentation, laboratory findings and mortality risk among patients of scrub typhus in western Himalayas. J Assoc Physicians India. 2016;64(3):26-30. [PubMed] [Google Scholar]
Sethuraman VK, Balasubramanian K. An unusual clinical presentation of scrub typhus. Cureus. 2019;11(9):e5568. [PubMed] [Google Scholar]
Mahajan SK, Kashyap R, Kanga A, Sharma V, Prasher BS, Pal LS. Relevance of Weil-Felix test in diagnosis of scrub typhus in India. J Assoc Physicians India. 2006;54:619- 21. [PubMed] [Google Scholar]
Kannan K, John R, Kundu D, Dayanand D, Abhilash KP, Mathuram AJ, Zachariah A, Sathyendra S, Hansdak SG,
Abraham OC, Gunasekaran K, Iyadurai R, Abraham AM, Prakash JA, Yesudhason BL, Veeraraghavan B, Kavitha ML, Jose LR, Sumana MN, Saravu K, Varghese GM. Performance of molecular and serologic tests for the diagnosis of scrub typhus. PLoS Negl Trop Dis. 2020;14(11):e0008747. [PubMed] [Google Scholar]
Pattnaik SK, Ray B, Sinha S, Mohanty A, Sahu S. Outbreak of scrub typhus in Odisha – an emerging threat. Intensive Care Med Exp. 2015;3(1):A355. [Google Scholar]
Rapsang AG, Bhattacharyya P. Scrub typhus. Indian J Anaesth. 2013;57(2):127-34. [PubMed] [Google Scholar]
Poomalar GK, Rekha R. A case series of scrub typhus in obstetrics. J Clin Diagn Res. 2014;8(12):OR01-3.
[PubMed] [Google Scholar]
Bal M, Mohanta MP, Sahu S, Dwibedi B, Pati S, Ranjit M. Profile of pediatric scrub typhus in Odisha, India. Indian Pediatr. 2019;56(4):304-6. [Google Scholar]
Ramyasree A, Kalawat U, Rani ND, Chaudhury A. Seroprevalence of scrub typhus at a tertiary care
hospital in Andhra Pradesh. Indian J Med Microbiol. 2015;33(1):68-72. [PubMed] [Google Scholar]
Jakharia A, Borkakoty B, Biswas D, Yadav K, Mahanta J. Seroprevalence of scrub typhus infection in Arunachal Pradesh, India. Vector Borne Zoonotic Dis. 2016;16(10):659-63. [PubMed] [Google Scholar]
Sengupta M, Anandan S, Daniel D, Prakash JA. Scrub typhus seroprevalence in healthy Indian population. J Clin Diagn Res. 2015;9(10):DM01-2. [PubMed] [Google Scholar]
Khan SA, Bora T, Laskar B, Khan AM, Dutta P. Scrub typhus leading to acute encephalitis syndrome, Assam,
India. Emerg Infect Dis. 2017;23(1):148-50. [PubMed] [Google Scholar]
Wu YC, Qian Q, Magalhaes RJ, Han ZH, Haque U, Weppelmann TA, Hu WB, Liu YX, Zhang WY, Li SL. Rapid increase in scrub typhus incidence in mainland China, 2006–2014. Am J Trop Med Hyg. 2016;94(3):532-6.
[PubMed] [Google Scholar]
Lakshmi RM, Dharma TV, Sudhaharan S, Surya SM, Emmadi R, Yadati SR, Modugu NR, Jyotsna A. Prevalence of scrub typhus in a tertiary care centre in Telangana, south India. Iran J Microbiol. 2020;12(3):204-8.
[PubMed] [Google Scholar]
Roopa KS, Karthika K, Sugumar M, Bammigatti C, Shamanna SB, Harish BN. Serodiagnosis of scrub typhus
at a tertiary care hospital from southern India. J Clin Diagn Res. 2015;9(11):DC05-7. [PubMed] [Google
Scholar]
Subbalaxmi MV, Madisetty MK, Prasad AK, Teja VD, Swaroopa K, Chandra N, Upadhyaya AC, Shetty M, Rao MN, Raju YS, Lakshmi V. Outbreak of scrub typhus in Andhra Pradesh – experience at a tertiary care hospital. J Assoc Physicians India. 2014;62(6):490-6. [PubMed] [Google Scholar]
Vikram K, Agarwala P, Bhargava A, Jain Y, Jagzape T, Wasnik P. Scrub typhus and leptospirosis in rural and urban settings of central India: a preliminary evaluation. Trop Doct. 2020;50(2):111-5. [PubMed]
[Google Scholar]
Sharma P, Kakkar R, Kaore SN, Yadav VK, Sharma R. Geographical distribution, effect of season & life cycle of scrub typhus. JK Sci. 2010;12(2):63-4. [Google Scholar]
Tilak R, Anand V. Mite and tick-borne diseases in India: challenges and the way forward. J Med Arthropodol Public Health. 2021;1(1):9-14. [Google Scholar]
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