IAMAT |International Association of Medical Assistance to Travellers| IAMAT |International Association of Medical Assistance to Travellers|

Country Health Advice Nepal

For Specific Travellers: Scrub Typhus

Nepal has confirmed Scrub Typhus cases in the following districts: Chitwan, Gulmi, Morang, Nawalparasi, Nuwakot, and Sankhuwasabha district.  Kathmandu has also confirmed Scrub Typhus cases.

For the latest information on Scrub Typhus outbreaks please go to: ProMED-mail. Vector borne diseases - Nepal: (Chitwan) fatal. ProMED-mail 2018; January 19: 20180119.5568889.<ProMED-mail>. Accessed on January 19, 2018.

Description

Scrub Typhus, also known as Tsutsugamushi Disease, is caused by Orienta tsutsugamushi bacteria. It is a zoonosis (an animal disease that can spread to humans) primarily affecting rodents, rabbits, and marsupials. This rickettsial infection is transmitted to humans through the bite of infected Leptotombidium mite larvae (chiggers). The mites are found in grasslands, forests, bush areas, wood piles, gardens, and beaches. Scrub Typhus can also be transmitted through unscreened blood transfusions and unhygienic needles. It does not spread from person to person.

>> Travel health advice on Epidemic Typhus and Murine Typhus.

Risk

The infection is endemic in Central Asia, southeast Asia, and northern Australia. Travellers undertaking outdoor activities such as visiting farms, camping, backpacking, hunting, archeological digs, or participating in ecotourism are at risk of getting bitten by chiggers. Scrub Typhus is an occupational health concern for farmers, park rangers, military personnel, geologist, miners, as well as oil palm workers. The presence of Scrub Typhus is related to increasing deforestation and urbanization. Scrub Typhus typically occurs during the rainy season, but can be present throughout the year.

Symptoms

Usually symptoms appear 6 to 20 days after exposure to the bacteria and include fever, headache, chills, sweating, muscle pain, eye infection, skin rash, and lymph node swelling. Often the bite area becomes red and a black scab, also known as an ‘eschar’, forms at the center. If untreated, the infection can progress to more severe symptoms including pneumonia, jaundice, hemorrhaging, multi-organ failure, and paralysis which can lead to death. Treatment includes a course of antibiotics and supportive care of symptoms.

Prevention

Travellers who engage in hiking, camping, or similar outdoor activities in endemic regions  should take measures to prevent mite bites. There is no vaccine or preventive medication against Scrub Typhus.

  • Apply a DEET-containing repellent to exposed skin and soak clothing and gear in a permethrin solution. 
  • When hiking in wooded areas, stay in the middle of the trail and avoid tall grasses and shrubs. Wear long shirts and pants tucked into socks. 
  • Avoid walking barefoot or wearing sandals, and use a tarp when sitting on ground cover. 
  • If you’re going to an area where Scrub Typhus is endemic, ask your healthcare practitioner about preventive antibiotics.

Scrub Typhus images, life cycle, and distribution maps
Infection Landscapes

Health risk description last reviewed: September 15, 2016
Country information last updated: March 29, 2018


Sources

  • Kim I-S, Walker D. Scrub Typhus. In: Guerrant, R; Walker D; Weller P, eds. Tropical Infectious Diseases. 3rd ed. New York: Saunders Elsevier; 2011: 334-338.
  • Newton PN, Day NPJ. Scrub Typhus. In: McGill, A; Ryan, E; Hill, D; Solomon, T, eds. Hunter's Tropical Medicine and Emerging Infectious Diseases. 9th ed. New York: Saunders Elsevier; 2013: 542-545.
  • Wertheim, Heiman; Horby, Peter; Woodall, John, eds. Atlas of Human Infectious Diseases. Oxford: Wiley-Blackwell; 2012. 273 p.
  • Northern Territory Government, Australia: Scrub Typhus Fact Sheet
  • World Health Organization: Frequently Asked Questions Scrub Typhus


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