Epidemiology of scrub typhus and other rickettsial infections (2018-22) in the hyper-endemic setting of Mizoram, North-East India

In the last decade, there has been an emergence of scrub typhus in many parts of India. In Mizoram, North-East India, there has been a steep increase in scrub typhus and other rickettsial infections in the last 5 years. As part of the public health response, the Mizoram Government has integrated screening (by rapid immunochromatographic test and/or Weil-Felix test) and line listing of scrub typhus and other rickettsial infections across all its health settings, a first in India. From 2018-22 (study period), 22914 cases were reported; of these, 19651 were positive for scrub typhus. Aizawl district is the worst affected, with 10580 cases (46.17%). The average incidence rate of rickettsial infections is 3.54 cases per 1000 persons-year, and the case fatality rate is 0.35. Patients with eschar (aOR=2.5, p