If you are in an area where scrub typhus is being reported and develop a high fever, particularly with shaking chills, severe headache, body ache, swollen lymph nodes or a painless dark crust from a chigger bite, seek medical care promptly.

If you are in the scrub typhus prone area like Salyan, doctors advise seeking immediate care. People in other areas should also seek testing and treatment if their fever does not improve after three days.

Scrub typhus can be treated with antibiotics, and the medicines are available free of cost at state-run health facilities. Health officials have also supplied testing kits and medicines to affected areas.

Here’s everything you need to know about scrub typhus

More than 9,000 people across Nepal have been infected with scrub typhus since January, according to the Epidemiology and Disease Control Division. The disease has been reported in 74 of the country’s 77 districts, with 2,718 people infected in the past month alone.

In Salyan’s Darma Rural Municipality, more than 600 people have been infected and eight have died. 

“The disease has been spread in all wards of our municipality and over 30 people are testing positive to the disease every day,” said Yagya Bahadur Basnet, health coordinator of the rural municipality. “Along with the infection, a kind of panic has spread in our area and people are rushing to Dang and Nepalgunj when they suffer from fever.”

Last year, more than 10,000 people across the country were infected, while the number stood at 16,597 in fiscal year 2024–25. Officials say the actual number could be higher because not all infections are recorded in government data.

Health officials say the exact number of deaths from scrub typhus is unknown. The infection can cause complications including renal and lung failure, pneumonia and multiple-organ failure, making it difficult to determine whether it was responsible for some deaths.

“One may die of renal failure or lung failure, pneumonia after the infection of scrub typhus,” said Dr Gokarna Dahal, chief of the Vector Control Section at the division. “And people already having underlying conditions have high chances of getting severe and dying. So it is not easy to identify whether the disease is responsible for deaths or not.”

What is scrub typhus?

Scrub typhus, also known as bush typhus, is a potentially fatal bacterial infection caused by Orientia tsutsugamushi. It is transmitted to humans through the bite of infected chiggers, or larval mites.

The disease was relatively unknown in Nepal until about a decade ago but has since emerged as a major public health problem.

“This is the peak scrub typhus season and a number of infections are being reported from all provinces and from many districts,” said Dr Anuj Bhattachan, director at the Epidemiology and Disease Control Division. “We have deployed an expert team comprising an entomologist in the disease-hit Salyan for surveillance and disease control.”

Who is at risk and when should you see a doctor?

Anyone can contract scrub typhus, as the disease has spread to almost all districts of the country. While people living in rural areas and those working on farms and in fields were previously considered most at risk, infections are now also being reported among people living in urban areas.

Doctors say people living in rural areas, farmers and herders are more vulnerable to infection.

People in areas experiencing outbreaks, including Salyan, should seek immediate medical attention if they develop high-grade fever accompanied by shaking chills, severe headache and body ache, swollen lymph nodes or a painless dark crust from a chigger bite.

“Scrub typhus is a bacterial infection and can be cured by minor antibiotics,” said Dr Anup Bastola, director at the Sukraraj Tropical and Infectious Disease Hospital. “Even the medicines are available free of cost at state-run health facilities.”

People in other areas should seek testing and treatment if their fever does not improve after three days.

What are the symptoms?

Scrub typhus can cause high fever, severe headache, abdominal pain, backache, joint and muscle pain, red rash, nausea and vomiting.

Severe cases can cause fatigue, confusion, chest infections and breathing difficulties. Patients may also develop internal bleeding, low blood pressure, renal and liver failure and, eventually, multiple-organ failure.

The infection can also cause respiratory distress and inflammation of the brain and lungs. If left untreated, it can be fatal.

“If patients are from disease-hit areas, don’t wait for the ailment to cure on its own,” said Dr Sher Bahadur Pun, chief of the Clinical Research Unit at Sukraraj Hospital. “Delay in starting treatment could be costly. Patients can fall into a coma and suffer multiorgan failure. Fever may be cured within 48 hours of taking medicines.”

Is there a vaccine or treatment?

There is currently no vaccine against scrub typhus. But health officials have ensured the availability of common antibiotics, including doxycycline and azithromycin, at state-run health facilities.

The medicines are on the government’s essential drugs list and are distributed free of cost to health facilities across the country.

Dahal said the Epidemiology and Disease Control Division had supplied test kits to affected areas and that testing and medicines were available at nearby health facilities.

Doctors can diagnose scrub typhus based on symptoms, but the risk of misdiagnosis is high because its symptoms are similar to those of other illnesses.

How to protect yourself?

There is no vaccine against scrub typhus, so prevention focuses on avoiding infected chiggers. People working in fields, grass or bushes should wear long sleeves and trousers and use insect repellent on exposed skin. Clothing and boots can also be treated with 0.5 percent permethrin, but it should not be applied directly to the skin.

Avoid sitting or lying directly on grass or vegetation. After working outdoors, change and wash your clothes and bathe.