{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T21:22:04Z","timestamp":1789852924725,"version":"4.0.1"},"reference-count":52,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T00:00:00Z","timestamp":1781395200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T00:00:00Z","timestamp":1781395200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Scrub typhus is a major yet often unrecognised cause of acute undifferentiated febrile illness (AUFI) in India. Delayed diagnosis contributes substantially to organ dysfunction and mortality, but accurate estimates of disease burden are limited by heterogeneous diagnostic practices. Understanding the proportion of clinically suspected cases attributable to scrub typhus is essential for improving early recognition and treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a systematic review and meta\u2010analysis of studies reporting IgM enzyme\u2010linked immunosorbent assay (ELISA) confirmed scrub typhus among patients presenting with acute febrile illness in India. Searches of major databases were conducted through August 2025. A random\u2010effects model with DerSimonian\u2013Laird estimator and Hartung\u2013Knapp\u2013Sidik\u2013Jonkman adjustment was used to estimate pooled prevalence. Freeman\u2013Tukey double arcsine transformation was applied to stabilise variances. Study quality was assessed with the Joanna Briggs Institute checklist. Heterogeneity, publication bias and influence diagnostics were evaluated using both advanced and standard statistical tests and graphical tools.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 44 studies involving 67,179 clinically suspected cases met eligibility criteria. The pooled prevalence of scrub typhus was 29.3% (95% CI: 22.3%\u201337.3%). Prevalence varied widely across regions (0.63%\u201393.10%). Sensitivity analyses demonstrated that no single study materially altered the pooled prevalence. Publication bias was minimal. The Doi plot showed minor asymmetry (LFK index, 1.47), whereas Egger's regression and Begg's test indicated no statistically significant publication bias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This meta\u2010analysis reveals that scrub typhus accounts for nearly one\u2010third of suspected febrile illnesses in India (pooled prevalence: 29.3%). Clinicians in endemic regions should maintain a high index of suspicion and initiate timely therapy. Improved access to standardised diagnostics and molecular testing is essential to reduce morbidity and mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/tmi.70185","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:05:01Z","timestamp":1781481901000},"page":"1172-1182","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Sero\u2010Diagnosis of Scrub Typhus Infection in India: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"31","author":[{"given":"Jogender","family":"Yadav","sequence":"first","affiliation":[{"name":"Department of Microbiology All India Institute of Medical Sciences  Bhopal India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7466-1037","authenticated-orcid":false,"given":"Santenna","family":"Chenchula","sequence":"additional","affiliation":[{"name":"Department of Pharmacology All India Institute of Medical Sciences  Bhopal India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ram Kumar","family":"Nema","sequence":"additional","affiliation":[{"name":"Division of Environmental Biotechnology, Genetics and Molecular Biology ICMR\u2013National Institute for Research in Environmental Health  Bhopal India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5903-3366","authenticated-orcid":false,"given":"Jyoti Kant","family":"Choudhari","sequence":"additional","affiliation":[{"name":"Department of Microbiology All India Institute of Medical Sciences  Bhopal India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3542-2401","authenticated-orcid":false,"given":"Shashank","family":"Purwar","sequence":"additional","affiliation":[{"name":"Department of Microbiology All India Institute of Medical Sciences  Bhopal India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,14]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13071-019-3751-x"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1086\/596576"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0006062"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0009619"},{"issue":"6","key":"e_1_2_8_6_1","first-page":"1350","article-title":"Scrub Typhus in Africa\u2014A Review","volume":"94","author":"Maina A. 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