{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T21:22:13Z","timestamp":1789852933956,"version":"4.0.1"},"reference-count":19,"publisher":"Scientific Scholar","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,3]]},"abstract":"\n \n Gorakhpur division consisting of Gorakhpur and neighboring districts Deoria, Kushinagar and Maharajganj in Uttar Pradesh, India, have been witnessing seasonal outbreaks of acute encephalitis syndrome (AES) among children for the last three decades. Investigations conducted during 2005 identified Japanese encephalitis (JE) virus as an aetiology of AES. With the introduction of JE vaccination and other control strategies, the incidence of JE in the region declined, however, outbreaks of acute febrile illness with neurological manifestations continued to occur. Subsequent investigations identified Orientia tsutsugamushi<\/jats:italic>, as the major aetiology of AES outbreaks in the region. This review details clinical, epidemiological, animal and entomological investigations conducted for AES due to O. tsutsugamushi<\/jats:italic> during 2015 and 2017 in Gorakhpur region. Surveillance of acute febrile illness among children attending peripheral health facilities identified scrub typhus as an important aetiology of febrile illness during monsoon and post-monsoon months. Population-based serosurveys indicated high endemicity of scrub typhus. Entomological studies demonstrated natural infection of O. tsutsugamushi<\/jats:italic> in small animal hosts and vector mites. Children acquired this infection through recent exposure to outdoor environment, while playing, or visiting fields or defecating in open fields. A few of the children with scrub typhus progress to develop CNS manifestations. Hence, early administration of appropriate antibiotics is crucial in preventing progression of AFI due to scrub typhus to AES. The investigations conducted by the multi-disciplinary team helped understand the transmission dynamics of scrub typhus in Gorakhpur division and recommend strategies for its control.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/ijmr.ijmr_625_21","type":"journal-article","created":{"date-parts":[[2021,12,6]],"date-time":"2021-12-06T06:43:27Z","timestamp":1638773007000},"page":"375-381","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":26,"title":["Investigations of seasonal outbreaks of acute encephalitis syndrome due to Orientia tsutsugamushi in Gorakhpur region, India"],"prefix":"10.25259","volume":"153","author":[{"given":"Manoj V.","family":"Murhekar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeromie Wesley","family":"Vivian Thangaraj","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Candasamy","family":"Sadanandane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahima","family":"Mittal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nivedita","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winsley","family":"Rose","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seema","family":"Sahay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajni","family":"Kant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohan D.","family":"Gupte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","reference":[{"key":"R1-19-20241212","first-page":"161","article-title":"Japanese encephalitis epidemic in Uttar Pradesh, India during 1978","volume":"75","author":"Mathur","year":"1982","journal-title":"Indian J Med Res"},{"key":"R2-19-20241212","first-page":"325","article-title":"JE virus encephalitis: 1988 epidemic at Gorakhpur","volume":"30","author":"Rathi","year":"1993","journal-title":"Indian Pediatr"},{"key":"R3-19-20241212","first-page":"50","article-title":"AES: Clinical presentation and sdilemmas in critical care management","volume":"46","author":"Mittal","year":"2014","journal-title":"J Commun Dis"},{"key":"R4-19-20241212","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.3201\/eid1909.121855","article-title":"Acute encephalitis syndrome surveillance, Kushinagar District, Uttar Pradesh, India, 2011\u20132012","volume":"19","author":"Kakkar","year":"2013","journal-title":"Emerg Infect Dis"},{"key":"R5-19-20241212","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.jinf.2014.03.013","article-title":"Changes in acute encephalitis syndrome incidence after introduction of Japanese encephalitis vaccine in a region of India","volume":"69","author":"Ranjan","year":"2014","journal-title":"J Infect"},{"key":"R6-19-20241212","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.3201\/eid1209.060200","article-title":"Japanese encephalitis outbreak, India, 2005","volume":"12","author":"Parida","year":"2006","journal-title":"Emerg Infect Dis"},{"key":"R7-19-20241212","doi-asserted-by":"crossref","first-page":"374","DOI":"10.4103\/2224-3151.207040","article-title":"A review of Japanese encephalitis in Uttar Pradesh, India","volume":"1","author":"Kumari","year":"2012","journal-title":"WHO South-East Asia J Public Health"},{"key":"R9-19-20241212","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1016\/j.jinf.2016.08.014","article-title":"Acute encephalitis syndrome in Gorakhpur, Uttar Pradesh, India - Role of scrub typhus","volume":"73","author":"Murhekar","year":"2016","journal-title":"J Infect"},{"key":"R10-19-20241212","doi-asserted-by":"crossref","first-page":"1414","DOI":"10.3201\/eid2308.170025","article-title":"Scrub typhus as a cause of acute encephalitis syndrome, Gorakhpur, Uttar Pradesh, India?","volume":"23","author":"Mittal","year":"2017","journal-title":"Emerg Infect Dis"},{"key":"R11-19-20241212","doi-asserted-by":"crossref","first-page":"368","DOI":"10.4269\/ajtmh.2010.09-0233","article-title":"Diagnosis of scrub typhus","volume":"82","author":"Koh","year":"2010","journal-title":"Am J Trop Med Hyg"},{"key":"R12-19-20241212","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1086\/313906","article-title":"Multiple organ failure complicating probable scrub typhus","volume":"31","author":"Cracco","year":"2000","journal-title":"Clin Infect Dis"},{"key":"R13-19-20241212","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1097\/INF.0000000000002099","article-title":"Acute encephalitis syndrome in Gorakhpur, Uttar Pradesh, 2016: Clinical and laboratory findings","volume":"37","author":"Mittal","year":"2018","journal-title":"Pediatr Infect Dis J"},{"key":"R14-19-20241212","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.4269\/ajtmh.17-0135","article-title":"Scrub Typhus as an etiology of acute febrile illness in Gorakhpur, Uttar Pradesh, India, 2016","volume":"97","author":"Thangaraj","year":"2017","journal-title":"Am J Trop Med Hyg"},{"key":"R17-19-20241212","doi-asserted-by":"crossref","first-page":"350","DOI":"10.4103\/ijmr.IJMR_1330_18","article-title":"Seroprevalence & seroincidence of Orientia tsutsugamushi infection in Gorakhpur, Uttar Pradesh, India: A community-based serosurvey during lean (April-May) & epidemic (October-November) periods for acute encephalitis syndrome","volume":"151","author":"Kamble","year":"2020","journal-title":"Indian J Med Res"},{"key":"R18-19-20241212","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1089\/vbz.2017.2246","article-title":"Occurrence of Orientia tsutsugamushi, the etiological agent of scrub typhus in animal hosts and mite vectors in areas reporting human cases of acute encephalitis syndrome in the Gorakhpur Region of Uttar Pradesh, India","volume":"18","author":"Sadanandane","year":"2018","journal-title":"Vector Borne Zoonotic Dis"},{"key":"R19-19-20241212","doi-asserted-by":"crossref","first-page":"2364","DOI":"10.3201\/eid2412.180695","article-title":"Risk factors for acquiring scrub typhus among children in Deoria and Gorakhpur Districts, Uttar Pradesh, India, 2017","volume":"24","author":"Thangaraj","year":"2018","journal-title":"Emerg Infect Dis"},{"key":"R21-19-20241212","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1007\/s13312-020-1889-4","article-title":"Effectiveness of Presumptive Treatment of Acute febrile illness with doxycycline or azithromycin in preventing acute encephalitis syndrome in Gorakhpur, India: A cohort study","volume":"57","author":"Thangaraj","year":"2020","journal-title":"Indian Pediatr"},{"key":"R22-19-20241212","doi-asserted-by":"crossref","first-page":"e52","DOI":"10.1097\/INF.0000000000002595","article-title":"Sequelae following acute encephalitis syndrome caused by Orientia tsutsugamushi","volume":"39","author":"Prakash Gangwar","year":"2020","journal-title":"Pediatr Infect Dis J"},{"key":"R23-19-20241212","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1007\/s13312-020-1885-8","article-title":"Presumptive Treatment of acute febrile illness for preventing acute encephalitis syndrome: Does it work?","volume":"57","author":"Aneja S and Joshi","year":"2020","journal-title":"Indian Pediatr"}],"container-title":["Indian Journal of Medical Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.4103\/ijmr.IJMR_625_21","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T23:03:47Z","timestamp":1751497427000},"score":1,"resource":{"primary":{"URL":"https:\/\/ijmr.org.in\/investigations-of-seasonal-outbreaks-of-acute-encephalitis-syndrome-due-to-orientia-tsutsugamushi-in-gorakhpur-region-india-a-one-health-case-study\/"}},"subtitle":["A One Health case study"],"short-title":[],"issued":{"date-parts":[[2021,3]]},"references-count":19,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.4103\/ijmr.ijmr_625_21","relation":{},"ISSN":["0971-5916"],"issn-type":[{"value":"0971-5916","type":"print"}],"subject":[],"published":{"date-parts":[[2021,3]]}}}