Three months after two massive earthquakes struck Nepal in 2015, BP Koirala Institute of Health Sciences, Dharan alerted the Epidemiology and Disease Control Division about six children with unusual fever and severe respiratory features.

Four children died during treatment as serum samples were collected for subsequent tests in Kathmandu and Bangkok that confirmed a scrub typhus outbreak. By the end of the year, 101 cases were confirmed in 16 districts and four more people succumbed to the disease.

“Nepal had never reported so many cases of scrub typhus at once and we also lacked specialists to deal with the disease,” former director at the division, Dr Baburam Marasini told the Post.

“After entomologists from the World Health Organisation and an expert from India arrived, a surveillance system was set up across the country, specially in the area the six children came from.”

The magnitude of the outbreak escalated in 2016—831 cases of scrub typhus were reported in 47 districts and 14 people died by the end of that year.Scrub typhus, also known as bush typhus is an infectious disease that is caused by the parasite Orientia tsutsugamushi, a mite-borne bacterium, and spreads in the human body after they are bitten by infected chiggers (larval mites) found in mice.

Authorities have confirmed 1,435 people infected with scrub typhus across the country since then. Ten people have died till date. Scrub typhus continues to rise and spread to the hills and mountains as temperatures become more favourable for parasites, epidemiologists warned.

Shukraraj Tropical and Infectious Disease Hospital Chief Consultant Dr Anup Bastola said, “The earthquake rendered many people homeless and forced them to live in temporary shelters where they might have acquired scrub typhus because of rodent infestation.

“On checking the background of most of our patients diagnosed with the disease, we see that they are still living in temporary shelters.”

Dr Bastola is one of the authors of the report on the outbreak of scrub typhus in the aftermath of earthquake in Nepal. The report says over 60 percent of the patients admitted and diagnosed with scrub typhus at Sukraraj Hospital from August to October 2015 came from Dhading district, followed by Nuwakot, Sarlahi, Kavre and Parsa. The earthquake in 2015 devastated all districts except Sarlahi.

A 2017 report by the National Health Research Council reveals the highest incidence of the disease in Chitwan district, with 34.4 percent of the total patients diagnosed with scrub typhus from the period of January to October.

The council’s report clearly indicates scrub typhus as a re-emerging disease problem in Nepal. The disease infected children and young adults the most followed by women-more than half of the cases in Chitwan were below 30 years of age, of that 14.5% were children below 10 years of age.

“The incidence of the disease is higher among women and children because of their exposure to vegetation. The outbreak was similar in 2015 while many people were living in temporary shelters,” said Dr Marasini.

Division Vector Control Inspector Rajendra Mishra told the Post, “Rodents in Chitwan still test positive for chigger mites and the risks are higher for people in Chitwan because most of them are involved in agriculture.”

Symptoms of scrub typhus include fever with chills, head and body aches, muscle pain, dark scab-like regions on the bitten spot, mental changes, enlarged lymph nodes and rashes.Sukraraj Hospital Chief Medical Officer Dr Sher Bahadur Pun, told the Post, “The disease can affect kidney, liver, and brain and lungs as well. If not treated early, it can even claim lives.

“People working in agricultural sector should use clothes to cover their entire body. People should avoid areas with lots of vegetation and bushes where mites may be found.”