Clinical and Epidemiological Patterns of Scrub Typhus, an Emerging Disease in Bhutan
Scrub typhus (ST) is a vector-borne rickettsial infection causing acute febrile illness. The re-emergence of ST in the Asia-Pacific region represents a serious public health threat. ST was first detected in Bhutan in 2008. However, the disease is likely to be under-diagnosed and under-reported, and...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2019-03-01
|
| Series: | Tropical Medicine and Infectious Disease |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2414-6366/4/2/56 |
| _version_ | 1798034631621083136 |
|---|---|
| author | Kezang Dorji Yoenten Phuentshok Tandin Zangpo Sithar Dorjee Chencho Dorjee Peter Jolly Roger Morris Nelly Marquetoux Joanna McKenzie |
| author_facet | Kezang Dorji Yoenten Phuentshok Tandin Zangpo Sithar Dorjee Chencho Dorjee Peter Jolly Roger Morris Nelly Marquetoux Joanna McKenzie |
| author_sort | Kezang Dorji |
| collection | DOAJ |
| description | Scrub typhus (ST) is a vector-borne rickettsial infection causing acute febrile illness. The re-emergence of ST in the Asia-Pacific region represents a serious public health threat. ST was first detected in Bhutan in 2008. However, the disease is likely to be under-diagnosed and under-reported, and the true impact is difficult to estimate. At the end of 2014, the SD Bioline Tsutsugamushi Test<sup>TM</sup> rapid diagnostic test (RDT) kits became available in all hospitals to assist clinicians in diagnosing ST. We conducted a retrospective descriptive study, reviewing records from all hospitals of Bhutan to identify all RDT-positive clinical cases of ST in Bhutan in 2015. The aim was to evaluate the burden of ST in Bhutan, describe the demographic, spatial and temporal patterns of disease, and identify the typical clinical presentations. The annual incidence of RDT-positive cases of ST reporting to Bhutanese hospitals in 2015 was estimated to be 62 per 100,000 population at risk. The incidence of disease was highest in the southern districts with a subtropical climate and a high level of agricultural production. The highest proportion of cases (87%) was rural residents, with farmers being the main occupational category. The disease was strongly seasonal, with 97% of cases occurring between June and November, coinciding with the monsoon and agricultural production seasons. Common ST symptoms were not specific, and an eschar was noted by clinicians in only 7.4% of cases, which is likely to contribute to an under-diagnosis of ST. ST represents an important and neglected burden, especially in rural communities in Bhutan. The outcomes of this study will inform public health measures such as timely-awareness programmes for clinicians and the public in high-risk areas, to improve the diagnosis, treatment and clinical outcomes of this disease. |
| first_indexed | 2024-04-11T20:46:54Z |
| format | Article |
| id | doaj.art-239179664ccb4e69b1022a69b178bcf7 |
| institution | Directory Open Access Journal |
| issn | 2414-6366 |
| language | English |
| last_indexed | 2024-04-11T20:46:54Z |
| publishDate | 2019-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Tropical Medicine and Infectious Disease |
| spelling | doaj.art-239179664ccb4e69b1022a69b178bcf72022-12-22T04:03:59ZengMDPI AGTropical Medicine and Infectious Disease2414-63662019-03-01425610.3390/tropicalmed4020056tropicalmed4020056Clinical and Epidemiological Patterns of Scrub Typhus, an Emerging Disease in BhutanKezang Dorji0Yoenten Phuentshok1Tandin Zangpo2Sithar Dorjee3Chencho Dorjee4Peter Jolly5Roger Morris6Nelly Marquetoux7Joanna McKenzie8School of Veterinary Science, Massey University, Palmerston North 4442, New ZealandSchool of Veterinary Science, Massey University, Palmerston North 4442, New ZealandSchool of Veterinary Science, Massey University, Palmerston North 4442, New ZealandFaculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu 11001, BhutanFaculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu 11001, BhutanSchool of Veterinary Science, Massey University, Palmerston North 4442, New ZealandMorvet Ltd., Consultancy Services in Health Risk Management and Food Safety Policy and Programs, Masterton 5885, New ZealandSchool of Veterinary Science, Massey University, Palmerston North 4442, New ZealandSchool of Veterinary Science, Massey University, Palmerston North 4442, New ZealandScrub typhus (ST) is a vector-borne rickettsial infection causing acute febrile illness. The re-emergence of ST in the Asia-Pacific region represents a serious public health threat. ST was first detected in Bhutan in 2008. However, the disease is likely to be under-diagnosed and under-reported, and the true impact is difficult to estimate. At the end of 2014, the SD Bioline Tsutsugamushi Test<sup>TM</sup> rapid diagnostic test (RDT) kits became available in all hospitals to assist clinicians in diagnosing ST. We conducted a retrospective descriptive study, reviewing records from all hospitals of Bhutan to identify all RDT-positive clinical cases of ST in Bhutan in 2015. The aim was to evaluate the burden of ST in Bhutan, describe the demographic, spatial and temporal patterns of disease, and identify the typical clinical presentations. The annual incidence of RDT-positive cases of ST reporting to Bhutanese hospitals in 2015 was estimated to be 62 per 100,000 population at risk. The incidence of disease was highest in the southern districts with a subtropical climate and a high level of agricultural production. The highest proportion of cases (87%) was rural residents, with farmers being the main occupational category. The disease was strongly seasonal, with 97% of cases occurring between June and November, coinciding with the monsoon and agricultural production seasons. Common ST symptoms were not specific, and an eschar was noted by clinicians in only 7.4% of cases, which is likely to contribute to an under-diagnosis of ST. ST represents an important and neglected burden, especially in rural communities in Bhutan. The outcomes of this study will inform public health measures such as timely-awareness programmes for clinicians and the public in high-risk areas, to improve the diagnosis, treatment and clinical outcomes of this disease.https://www.mdpi.com/2414-6366/4/2/56scrub typhusOne Healthincidenceclinical patterndescriptive epidemiologyvector-borne diseaseemerging disease |
| spellingShingle | Kezang Dorji Yoenten Phuentshok Tandin Zangpo Sithar Dorjee Chencho Dorjee Peter Jolly Roger Morris Nelly Marquetoux Joanna McKenzie Clinical and Epidemiological Patterns of Scrub Typhus, an Emerging Disease in Bhutan Tropical Medicine and Infectious Disease scrub typhus One Health incidence clinical pattern descriptive epidemiology vector-borne disease emerging disease |
| title | Clinical and Epidemiological Patterns of Scrub Typhus, an Emerging Disease in Bhutan |
| title_full | Clinical and Epidemiological Patterns of Scrub Typhus, an Emerging Disease in Bhutan |
| title_fullStr | Clinical and Epidemiological Patterns of Scrub Typhus, an Emerging Disease in Bhutan |
| title_full_unstemmed | Clinical and Epidemiological Patterns of Scrub Typhus, an Emerging Disease in Bhutan |
| title_short | Clinical and Epidemiological Patterns of Scrub Typhus, an Emerging Disease in Bhutan |
| title_sort | clinical and epidemiological patterns of scrub typhus an emerging disease in bhutan |
| topic | scrub typhus One Health incidence clinical pattern descriptive epidemiology vector-borne disease emerging disease |
| url | https://www.mdpi.com/2414-6366/4/2/56 |
| work_keys_str_mv | AT kezangdorji clinicalandepidemiologicalpatternsofscrubtyphusanemergingdiseaseinbhutan AT yoentenphuentshok clinicalandepidemiologicalpatternsofscrubtyphusanemergingdiseaseinbhutan AT tandinzangpo clinicalandepidemiologicalpatternsofscrubtyphusanemergingdiseaseinbhutan AT sithardorjee clinicalandepidemiologicalpatternsofscrubtyphusanemergingdiseaseinbhutan AT chenchodorjee clinicalandepidemiologicalpatternsofscrubtyphusanemergingdiseaseinbhutan AT peterjolly clinicalandepidemiologicalpatternsofscrubtyphusanemergingdiseaseinbhutan AT rogermorris clinicalandepidemiologicalpatternsofscrubtyphusanemergingdiseaseinbhutan AT nellymarquetoux clinicalandepidemiologicalpatternsofscrubtyphusanemergingdiseaseinbhutan AT joannamckenzie clinicalandepidemiologicalpatternsofscrubtyphusanemergingdiseaseinbhutan |