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Open AccessArticle

Clinical and Epidemiological Patterns of Scrub Typhus, an Emerging Disease in Bhutan

School of Veterinary Science, Massey University, Palmerston North 4442, New Zealand
Samdrup Jongkhar Hospital, Ministry of Health, Samdrup Jongkhar 41001, Bhutan
National Centre for Animal Health, Department of Livestock, Ministry of Agriculture and Forests, Serbithang, Thimphu 11001, Bhutan
Dechencholing BHU-I, Ministry of Health, Thimphu 11001, Bhutan
Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu 11001, Bhutan
Morvet Ltd., Consultancy Services in Health Risk Management and Food Safety Policy and Programs, Masterton 5885, New Zealand
Author to whom correspondence should be addressed.
Trop. Med. Infect. Dis. 2019, 4(2), 56;
Received: 13 February 2019 / Revised: 16 March 2019 / Accepted: 18 March 2019 / Published: 29 March 2019
(This article belongs to the Special Issue One Health and Zoonoses)
Scrub typhus (ST) is a vector-borne rickettsial infection causing acute febrile illness. The re-emergence of ST in the Asia-Pacific region represents a serious public health threat. ST was first detected in Bhutan in 2008. However, the disease is likely to be under-diagnosed and under-reported, and the true impact is difficult to estimate. At the end of 2014, the SD Bioline Tsutsugamushi TestTM rapid diagnostic test (RDT) kits became available in all hospitals to assist clinicians in diagnosing ST. We conducted a retrospective descriptive study, reviewing records from all hospitals of Bhutan to identify all RDT-positive clinical cases of ST in Bhutan in 2015. The aim was to evaluate the burden of ST in Bhutan, describe the demographic, spatial and temporal patterns of disease, and identify the typical clinical presentations. The annual incidence of RDT-positive cases of ST reporting to Bhutanese hospitals in 2015 was estimated to be 62 per 100,000 population at risk. The incidence of disease was highest in the southern districts with a subtropical climate and a high level of agricultural production. The highest proportion of cases (87%) was rural residents, with farmers being the main occupational category. The disease was strongly seasonal, with 97% of cases occurring between June and November, coinciding with the monsoon and agricultural production seasons. Common ST symptoms were not specific, and an eschar was noted by clinicians in only 7.4% of cases, which is likely to contribute to an under-diagnosis of ST. ST represents an important and neglected burden, especially in rural communities in Bhutan. The outcomes of this study will inform public health measures such as timely-awareness programmes for clinicians and the public in high-risk areas, to improve the diagnosis, treatment and clinical outcomes of this disease. View Full-Text
Keywords: scrub typhus; One Health; incidence; clinical pattern; descriptive epidemiology; vector-borne disease; emerging disease scrub typhus; One Health; incidence; clinical pattern; descriptive epidemiology; vector-borne disease; emerging disease
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Dorji, K.; Phuentshok, Y.; Zangpo, T.; Dorjee, S.; Dorjee, C.; Jolly, P.; Morris, R.; Marquetoux, N.; McKenzie, J. Clinical and Epidemiological Patterns of Scrub Typhus, an Emerging Disease in Bhutan. Trop. Med. Infect. Dis. 2019, 4, 56.

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