Descriptive epidemiology and identification of risk factors of clinical scrub typhus in people in Bhutan

Scrub typhus is an emerging disease in Bhutan that was first diagnosed in 2008. While a higher number of cases has been reported in recent years, it is strongly suspected that scrub typhus cases are not widely recognised and significantly more cases occur than are reported through the national surveillance system in Bhutan.


A prospective case-control study of scrub typhus cases identified amongst fever patients visiting health centres in Bhutan in late summer of 2015 is being conducted by Bhutanese doctors and veterinarians undertaking in a 2-year One Health Epidemiology Fellowship as part of the ‘Integrating Education and Action for One Health’ program funded by the European Union and implemented by Massey University.


The study involves people from the human and animal health sectors in Bhutan, and will provide information on both the risk factors associated with scrub typhus in their country and the clinical symptoms of laboratory-confirmed scrub typhus cases. In addition, the spatio-temporal pattern of all scrub typhus cases reported in Bhutan in 2015 will be analysed and rodents will be serologically tested for evidence of infection with the pathogenic agent Orientia tsutsugumushi, in houses of people enrolled in the study.


The findings of this research will be used to develop national guidelines for controlling scrub typhus through improved diagnosis and early treatment of cases, which should contribute to reducing the burden of this disease.  Furthermore, risk-factor information will be used to develop guidelines for the general public on ways in which they can reduce the risk of becoming infected with scrub typhus, and encourage people to seek early treatment if they experience symptoms that may be associated with infection.


The Fellowship participants are from the human health, animal health, and wildlife sectors and are studying together in a Master’s degree program in One Health epidemiology and biosecurity. Through this study they are applying their knowledge and collaborating to reduce the risks of endemic and emerging epidemic diseases transmitted from animals and wildlife to people in their country.


The ‘Integrating Education and Action for One Health’ program uses a One Health approach to strengthen capability and promote collaborative relationships between the human, animal and wildlife health sectors in Afghanistan, Bangladesh, Bhutan and Nepal. This is key to managing endemic and emerging epidemic and pandemic disease threats.


The ‘Integrating Education and Action for One Health’ program is funded by the European Union and implemented by Massey University. The contents of this article are the sole responsibility of Massey University.