Scrub typhus is a common bacterial infection in Asia caused by Orientia tsutsugamushi. This serological cohort study estimated the incidence of infection in a rural population in South India. Participants were enrolled through systematic sampling in 46 villages at baseline, and revisited the following year. Blood samples were tested for IgG antibodies using ELISA, followed by indirect immunofluorescence assays (IFA) in those positive for ELISA at both rounds. A case was defined as sero-conversion (ELISA), or at least a 4-fold titre increase (IFA), between the two time points. In addition to crude incidence rate estimates, we used piecewise linear rates across calendar months, with rates proportional to the monthly incidence of local hospital cases to address seasonality and unequal follow-up times. Of 402 participants, 61.7% were female. The mean age was 46.7 years, (range 13–88). 21 participants showed evidence for serological infection. The estimated incidence was 4.4 per 100 person-years (95% CI 2.8–6.7). The piecewise linear rates approach resulted in a similar estimate of 4.6 per 100 person years (95% CI 2.9–6.9). Considering previous estimates of symptomatic scrub typhus incidence in the same study population, only about 2–5% of infections may result in clinically relevant disease.

We recovered larval trombiculid mites (i.e. chiggers), vectors of scrub typhus, from small mammal hosts in Taiwan, and compared the relative degree of engorgement (RDE) of the dominant chigger (Leptotrombidium imphalum) from different hosts. Naturally occurring chiggers recovered from Rattus losea and Bandicota indica were 1·4x and 1·3x as engorged as those from Apodemus agrarius. Within each host species, RDE was negatively related to chigger loads, but was mostly unrelated to gender or to body or reproductive condition of hosts. We documented significant variation in chigger engorgement both within and among host species; to the extent that RDE is a proxy for fitness, this contradicts predictions of the Ideal Free Distribution (IFD) that the per capita fitness of vectors should be similar among hosts. Failure to meet predictions of the IFD may reflect the limited mobility of chiggers, which consequently must be less selective in the hosts on which they feed. Further disease control efforts should consider vector feeding success in addition to vector abundance and may be able to capitalize on the unsuitability of certain hosts in supporting disease vectors.

Experiments were conducted to investigate the potential for transmission of Orientia tsutsugamushi, the aetiological agent for scrub typhus, when naturally infected mite larvae were co-feeding with uninfected larvae. Larvae from colonies of Leptotrombidium deliense and L. imphalum infected with O. tsutsugamushi were used. Transmission of O. tsutsugamushi to previously uninfected L. deliense and Blankaartia acuscutellaris co-fed with infected L. deliense was shown to occur. The overall minimum rate of acquisition was 1·6% (4/258) for L. deliense and 2·5% (3/119) for B. acuscutellaris. When individual infected L. deliense were co-fed with B. acuscutellaris acquisition of O. tsutsugamushi was not detected. However, when 4 and 8 infected larvae were co-fed with B. acuscutellaris acquisition of O. tsutsugamushi was detected. Transmission of O. tsutsugamushi was not observed when uninfected L. deliense were co-fed with infected L. imphalum. This novel transmission route may explain the occurrence of rickettsiae in genera other than Leptotrombidium spp, which are considered to be the main vectors of O. tsutsugamushi.