Country continues to grapple with scrub typhusAt least 1,300 cases reported in the past five months; disease control office says the lack of trained health workers has delayed diagnosis.
The disease has been reported in 63 districts across the country so far. While the deadly disease continues to spread, with the number of patients rising every year, the authorities concerned have not done enough to contain it.
"We have been unable to address the scrub typhus problem as a national priority programme due to our failure to sensitise the issue and impart training to health workers," Dr Bibek Kumar Lal, director at the Epidemiology and Disease Control Division, told the Post.
Scrub typhus, also known as bush typhus, is an infectious disease caused by the parasite Orientia tsutsugamushi, a mite-borne bacterium. It spreads in humans when bitten by infected chiggers (larval mites) found in mice.
High fever, headache, abdominal pain, backache, joint and muscle pain, dull red rash, nausea and vomiting are some of the symptoms of scrub typhus infection. Patients with severe illness may develop bleeding which could lead to organ failure. If left untreated, it could be fatal.
Health officials say that people residing in the city's slums and villagers, who work in fields, are vulnerable to the disease.
According to Lal, the health authority has failed to combat scrub typhus effectively as a lot of patients are forced to undergo several tests due to the failure of health workers to diagnose the disease.
"A lot of our health workers have reported that patients suffering from scrub typhus come to hospitals when their conditions are already critical," Lal said. “The diagnosis is usually late because most patients are forced to visit big hospitals in the cities to find out what’s wrong with them."
Delayed diagnosis has also hit the patients and their families financially. By the time the patients are diagnosed, they have already spent thousands of rupees for several hospital visits and medical tests.
Uttam Raj Pyakurel, a vector control inspector at the division, said that without sensitising the issue and providing training to health workers, including doctors, the spread of scrub typhus will not lessen.
"But, due to financial constraints, we are not in a position to train the health workers," Pyakurel said. "We are also unable to carry out the entomological study of scrub typhus due to lack of entomologists."
Risk of fatality from the scrub typhus can be minimised if patients are diagnosed and treated early, according to health officials. Ordinary antibiotics like doxycycline, azithromycin and others on the essential drug list supplied by the government to health facilities across the country for free distribution can cure the disease.
Lal said that his office had supplied reagents to all health facilities across the country to carry out scrub typhus test on infected people.
"We are also coordinating with the World Health Organization to develop a national treatment guideline of scrub typhus and organise training programmes," he added.
Nepal saw a surge in scrub typhus cases after the 2015 earthquakes, which killed nearly 9,000 people.
Three months after two massive earthquakes, the BP Koirala Institute of Health Sciences, Dharan, had alerted the division about six children with unusual fever and severe respiratory features. Four of the children died in the course of treatment.
The disease was later confirmed through the patients’ serum sample tests in Kathmandu and Bangkok. By the end of the year, 101 scrub typhus cases were confirmed in 16 districts, while four more people went on to succumb to the disease.
The magnitude of the outbreak escalated in 2016 when 831 cases of scrub typhus were reported in 47 districts. Fourteen people died by the end of that year.