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. 2025 Sep;30(9):978-986.
doi: 10.1111/tmi.70010. Epub 2025 Jul 22.

Estimating scrub typhus and murine typhus incidence among adolescents and adults in Yangon, Myanmar

Win Thandar Oo  1   2 , Thomas R Bowhay  2 , Tin Ohn Myat  1   2 , Wah Win Htike  1 , Kay Thi Lwin  3 , Stuart D Blacksell  4   5 , Ampai Tanganuchitcharnchai  4 , Mayfong Mayxay  5   6   7 , Paul N Newton  4   5   7 , Matthew T Robinson  5   7 , James E Ussher  8 , David R Murdoch  9 , Hla Hla Win  3 , John A Crump  2
Affiliations

Estimating scrub typhus and murine typhus incidence among adolescents and adults in Yangon, Myanmar

Win Thandar Oo et al. Trop Med Int Health. 2025 Sep.

Abstract

Objectives: Rickettsioses are frequent causes of treatable febrile illness in Southeast Asia, including Myanmar. Accurate estimates of the incidence of rickettsioses are needed to inform investments in disease prevention and control. We sought to estimate the incidence of rickettsioses among adults and adolescents by combining sentinel hospital surveillance with a healthcare utilisation survey in Yangon, Myanmar.

Methods: We conducted a household-based healthcare utilisation survey in the Yangon Region from 12 March through 5 April 2018. Multipliers derived from this survey were then applied to scrub typhus, murine typhus, and spotted fever group rickettsioses infections identified from a study of adolescent and adult community-onset febrile illness done from 5 October 2015 through 4 October 2016 at Yangon General Hospital to estimate disease incidence. Acute serum was collected at enrolment and convalescent serum 14-30 days after enrolment. Confirmed acute scrub typhus, murine typhus, and spotted fever group infections were diagnosed by a ≥ 4-fold rise between acute and convalescent immunofluorescent antibody test titre to Orientia tsutsugamushi pooled Karp, Kato, and Gilliam antigens; Rickettsia typhi Wilmington strain; and Rickettsia honei and Rickettsia conorii antigens, respectively.

Results: After applying multipliers, we estimated the overall annual incidence of acute scrub typhus among adolescents and adults in the Yangon Region at 211 cases per 100,000 persons, and the overall estimate of acute murine typhus among adults and adolescents was 44 cases per 100,000 persons per year for 2015-2016. There were no confirmed spotted fever group infections.

Conclusions: We provide the first estimates of scrub typhus and murine typhus community incidence in Myanmar. Similar research in children and from other parts of Myanmar, as well as studies of illness duration, complications, and deaths, is needed to estimate the disease burden.

Keywords: Myanmar; incidence studies; murine typhus; scrub typhus; spotted fever group rickettsiosis.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Map of South and South‐East Asia showing Myanmar (a) and Yangon Region (b).
FIGURE 2
FIGURE 2
Surveillance pyramid showing multipliers used to account for incomplete case identification. Modified from Crump et al. [17] and Pisharody et al. [23]
See this image and copyright information in PMC

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