A scrub typhus outbreak that began in Salyan’s Darma Rural Municipality in July has continued to spread, with health authorities failing to bring the disease under control more than two months later.

At least 56 new infections were detected on Monday alone during tests conducted at health facilities across the district.

Health workers from the federal, provincial, district and local levels have been conducting health camps to identify and treat patients and investigate the outbreak. But health officials say a lack of awareness and failure among residents to take basic precautions have allowed the disease to persist.

Nine people have died from the disease, including eight in Darma and one in Chhatreshwari Rural Municipality. Within Salyan, 606 people have tested positive so far, including six who were diagnosed after seeking treatment outside the district.

According to data from the Health Service Office in Salyan, around 2,500 people have been tested for scrub typhus across the district. The positive cases include 185 in Darma, 82 in Kumakh, 194 in Bagchaur Municipality, two in Kalimati, 29 in Chhatreshwori, 53 in Kapurkot, nine in Bangad, one in Tribeni and 51 at Salyan District Hospital.

Health authorities and local units have stepped up testing and treatment as the disease continues to spread.

Scrub typhus is transmitted through the bite of infected chiggers, tiny mites commonly found in grass and vegetation. Health officials have been advising residents to wear clothing that covers the entire body while working in grass and forests, use boots that cover the legs up to the knees, wear gloves and clear bushes around their homes.

But many residents have continued to ignore the precautions, said Dr Pratibha BK, acting chief of the Health Service Office.

“People have not been taking adequate precautions despite repeated advice,” she said. “As the disease has spread across the district, we have intensified surveillance, testing and treatment.”

A team from the Epidemiology and Disease Control Division in Teku, Kathmandu, has also visited Darma and other local units to investigate how the disease is spreading, BK said. The team collected blood samples from some patients for laboratory testing before returning to Kathmandu.

The outbreak has persisted even as the rainy season has ended and winter approaches, said Yagya Bahadur Basnet, chief of the health section of Darma Rural Municipality.

“Scrub typhus, which usually spreads when people are bitten by mites found in forests during the rainy season, has not been brought under control and has spread to additional parts of the rural municipality,” he said.

Fifty-two people tested positive at various health facilities in Darma on Monday alone, Basnet said.

The number of deaths has been brought under control through treatment camps run jointly by the district health authorities and the local government, with doctors and other health workers providing care, he said.

But delayed testing remains a problem. Some people who develop fever buy strong medicines directly from medical shops instead of seeking testing and treatment at health facilities, Basnet said.

Most residents in rural parts of Salyan depend on agriculture for their livelihoods. They routinely work in fields, tend livestock and go into forests to collect grass and firewood, often without taking precautions against mite bites.

In Kumakh Rural Municipality, patients presenting with fever, headaches and other symptoms have also been testing positive for scrub typhus, said Man Singh Oli, chief of the rural municipality’s health section.

More than 200 people have been tested at different locations in the rural municipality, with 82 testing positive, Oli said. Most patients are being treated at local health facilities, while those with severe symptoms are being referred for further care.

Health officials say environmental conditions and limited awareness are contributing to the spread.

Tara Rijal, a public health officer at the Health Service Office in Salyan, said a specialist team from the Epidemiology and Disease Control Division had found large numbers of mites in forests across several local units.

The team also concluded that residents were failing to take precautions while cutting grass and collecting fodder, while poor sanitation around homes was contributing to the spread of the disease, Rijal said.

Authorities are therefore expanding their public health messaging beyond information about scrub typhus to include household and community sanitation, he said.

“We are not only raising awareness about the disease but also about sanitation and the need to keep surroundings clean,” Rijal said.