Nine people have died of scrub typhus in Salyan district in the past six weeks, as the disease spreads across the district.

Eight of the deaths were reported in Darma Rural Municipality and one in Chhatreshwori Rural Municipality, according to local health officials. The latest victim was a 51-year-old woman from Chhatreshwori who died while undergoing treatment in Nepalgunj, said Ganesh Man Dangi, a health officer at the rural municipality.

The dead include six men, two women and a child. They died while receiving treatment at various hospitals in Dang and Nepalgunj.

The outbreak was first detected in Darma Rural Municipality during the period from mid-July to mid-August and has since spread across Salyan. Nearly 600 people have now tested positive for the disease.

With infections and deaths continuing to rise, an investigation team from the Epidemiology and Disease Control Division in Teku, Kathmandu, has arrived in Salyan. The team is currently conducting an investigation in Darma Rural Municipality.

Health authorities have been running screening and treatment camps in different parts of the district to identify patients and provide treatment. As the number of infections and deaths has continued to climb, the District Health Office has stepped up awareness and sanitation campaigns in coordination with the local units.

Scrub typhus, also known as bush typhus, is a potentially fatal bacterial infection transmitted to humans by mites. People contract the disease when they are bitten by the larval stage of mites, known as chiggers, which are commonly found on infected rodents.

Dr Pratibha BK, acting chief of the District Health Office, urged people working in fields, grasslands and bushes to wear long-sleeved clothes and trousers to reduce the risk of infection. She also recommended using insect-repellent or insect-killing sprays on exposed areas of the skin.

BK said health authorities had intensified testing and treatment after the disease spread to communities across the district. The team from the division is conducting investigations in several parts of Darma. Patients with mild symptoms are being treated within the district, while those with complications are being referred to hospitals elsewhere.

More than 4,000 people had been tested for scrub typhus using diagnostic kits by Thursday, according to public health officer Tara Rijal. Of those, 129 tested positive in Darma Rural Municipality, 76 in Kumakh Rural Municipality, 28 in Chhatreshwori, 180 in Bagchaur Municipality, 54 in Kapurkot, eight in Bangad Kupinde Municipality, two in Kalimati and 48 at the District Hospital Salyan.

The disease has so far been detected in eight local units, with Darma reporting the highest number of cases.

Yagya Bahadur Basnet, chief of the health section at Darma Rural Municipality, said health camps and awareness programmes had been held, but the outbreak remained difficult to contain.

Man Singh Oli, chief of the health section at Kumakh Rural Municipality, said many people with high fever and headaches who did not recover after taking medication were later found to have scrub typhus when tested.

The number of infections is continuing to rise, Oli said. Those who test positive are being treated under the supervision of health workers.