Scrub typhus cases in Nagaland show seasonal rise, with improving response and lower fatalities

Khriezovonuo Roseline Belho

KOHIMA — A look at scrub typhus cases in Nagaland over the past four and a half years shows a substantial number of positive cases, with seasonal surges and improved healthcare response.

Scrub typhus, an endemic disease, was first detected in Nagaland nearly two decades ago. Medical experts Eastern Mirror spoke to agreed that while the disease is treatable, limited testing facilities and poor access to healthcare in the past led to a higher number of deaths. However, with better infrastructure today, early detection and interventions have resulted in a significant drop in fatalities.

Scrub typhus is endemic in regions such as Jammu and Kashmir, Himachal Pradesh, Uttarakhand, and the north-eastern states including Assam and Nagaland.

A dataset covering four and a half years, compiled by the Integrated Health Information Platform – Integrated Disease Surveillance Programme (IHIP-IDSP) Nagaland, was recently shared with this newspaper.

The highest number of confirmed scrub typhus cases was reported in 2022, with 21.58% of tested samples returning positive. The data also shows that cases generally start to rise in March-April, peaking between July and sometimes August to October, as seen in 2023.

In 2021, 885 samples were tested, of which 448 tested positive through a rapid testing kit, but only 21 (4.68%) were confirmed positive after further testing.

In 2022, a total of 11,239 samples were tested; 3,136 were positive via rapid test, and 677 (21.58%) were confirmed cases.  In 2023, 21,091 samples were tested, 5,655 via rapid test, with 512 (9.06%) confirmed positive.

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In 2024, 19,643 samples were tested; 5,378 positive via rapid, and 396 (7.36%) confirmed. For 2025 (till June), 9,556 samples were tested, 2,220 positive via rapid, and 123 (5.54%) were confirmed positive.

The IHIP-IDSP platform monitors all types of diseases, including scrub typhus, in real time. However, it does not maintain records of fatalities.

Rapid vs. confirmatory tests

State Surveillance Officer (IDSP) and Deputy Director of Health and Family Welfare (H&FW), Dr. Nyanthung Kikon, clarified that the rapid testing kit is not a confirmatory test.

He said that only specific diagnostic kits and the sensitivity of those kits can accurately detect scrub typhus, and the accuracy depends on the quality of collected samples.

As a precautionary measure, however, doctors begin treatment once the sample tests positive via the rapid test. With early warnings, he advised the public to seek treatment early.

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Public Health Specialist at H&FW, Dr. Nounengulie Kire, attributed the rise in scrub typhus cases to climate change and increased human activity in forested areas.

Scrub typhus is prevalent in scrub jungles where forests are regrowing after being cleared. As these natural habitats are disturbed, the mites that carry the disease infest rats, which then bring them into human settlements, including homes.

Even those who do not visit forests may still contract the disease, as human encroachment into natural habitats increases the likelihood of exposure, he added.

Signs and symptoms

Individuals are advised to inspect their bodies, especially soft areas like the armpit and groin, as chigger bites typically leave a black mark or scar in such areas—though not always.

Fever is often one of the early signs, but because it is a common symptom, people are encouraged to get tested if they develop a fever. According to Dr. Kire, many people delay visiting hospitals until symptoms become severe.

“The disease is not something to be panic about but people need to be more aware and maintain hygiene at home,” he added. Since scrub typhus is a vector-borne disease, the entire health department remains engaged in addressing the infection.

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According to IHIP-IDSP Nagaland data, most cases reported between 2021 and 2024 were among those aged 20 to 49. Within this group, the 30 to 39 age bracket reported the highest number of cases, followed by those aged 20–29, then 40–49.

It is assumed that these age groups are more active and involved in outdoor activities, leading to increased exposure.

The gender distribution of cases has been nearly equal. In 2024, 3,467 males (50.3%) tested positive, compared to 3,514 females (49.6%), with two transgender cases also recorded.

District-wise distribution

In 2024, Kohima reported the highest number of cases, accounting for 3,398 or 49.1 per cent of the total. This was followed by Mon with 1,837 cases (26.6%), Longleng with 487 (7.0%), Phek with 470 (6.8 %), and Dimapur with 271 (3.9%).

Other districts reported comparatively fewer cases: Tuensang had 228 (3.3 %), Wokha 62 (0.9%), Mokokchung 42 (0.6%), Kiphire 41 (0.6%), Noklak 35 (0.5%), Peren 42 (0.5%), and Zunheboto 16 (0.2%).

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A doctor from Kohima noted that scrub typhus affects people of all ages, including children, youth, and elders. It is common in areas such as forests, grasslands, and farmlands, especially during the rainy season. It spreads through bites from infected chiggers.

Listing the symptoms such as fever, head and body aches, rashes, and the development of an eschar at the bite site, he advised people to seek testing and treatment early, warning that untreated scrub typhus can lead to multi-organ failure and even death. The disease is, however, treatable with antibiotics and oral medication.

To reduce the risk of infection, he recommended wearing protective clothing and covering exposed skin when outdoors, especially in high-risk areas.

A study conducted by medical experts from Nagaland showed that scrub typhus was first reported at Longsa village in Mokokchung district in 2006. However, the disease drew public attention in 2007 when 24 people died of scrub typhus in Porba village, Phek district. The high death toll among a population of around 2,000 triggered widespread alarm.

(Khriezovonuo Roseline Belho is a student of Journalism and Mass Communication at The Assam Royal Global University, Guwahati, and interned with Eastern Mirror)