Scrub typhus: A serious public health issue in Nepal

The agro-climatic conditions, socio-economic situation, poor sanitation, low hygiene and health standards in Nepal are major contributing factors to the emergence of scrub typhus in Nepal. These outbreaks, along with poor diagnostic facilities, can lead to severe economic losses in a resource-limited country like Nepal. Diseases like avian influenza, leptospirosis, brucellosis, tuberculosis and rabies, that cause heavy socio-economic burden, have received huge attention of Government of Nepal and hence are among the top ten priority diseases. However, until now, scrub typhus is not considered a priority disease in Nepal, despite having severe outbreaks time to time. In order to diagnose and treat scrub typhus infection, low budget diagnostic tests such as Weil Felix are less efficient and poor in screening, and highly advanced & efficient tests are less likely to be available and are expensive. Nepal needs to explore appropriate and applicable test settings in primary health centers and referral laboratories in the country. Moreover, focus should be made on effective surveillance programs and public awareness campaigns, mice/rat control strategies, and improving sanitation, public health and hygiene measures for the people at most risk. In addition, health workers and professionals should be trained on early case detection, personal protection, proactive rodent control strategies, habitat destruction and good sanitation and hygiene practices.