<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03269266</url>
  </required_header>
  <id_info>
    <org_study_id>OXTREC 18-17</org_study_id>
    <nct_id>NCT03269266</nct_id>
  </id_info>
  <brief_title>Scrub Typhus RDT Study</brief_title>
  <official_title>A Multicentre Observational Study to Describe the Prevalence of Scrub Typhus Defined as a Positive Rapid Diagnostic Test Among Selected Patients Presenting With Fever to Clinics in Myanmar</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Myanmar Oxford Clinical Research Unit</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>University of Oxford</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Medical Action Myanmar</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Yae Township Hospital, Mon State</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Swiss Tropical &amp; Public Health Institute</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Defence Services Medical Academy (DSMA), Myanmar</agency>
      <agency_class>Other</agency_class>
    </collaborator>
  </sponsors>
  <source>Myanmar Oxford Clinical Research Unit</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      Fever is one of most common presenting complaints in clinics in tropical countries.&#xD;
      Rickettsial infections, enteric fever and leptospirosis are common and important causes of&#xD;
      undifferentiated fever in Southeast Asia. Scrub typhus is caused by Orientia tsutsugamushi&#xD;
      and humans are typically infected by a bite of an infected chigger (trombiculid mite larva).&#xD;
      Clinical diagnosis is unreliable for identifying scrub typhus, unless a tick eschar is&#xD;
      present which is almost pathognomonic for the disease in Southeast Asia. A combination of&#xD;
      culture, paired serology and PCR has been proposed as the gold-standard method for detection.&#xD;
      As a result laboratory confirmation is not widely available and the diagnosis is missed&#xD;
      frequently in clinical practice. Some progress has been made in developing such a test and&#xD;
      one promising candidate is the Scrub Typhus Detect IgM Rapid Test (InBios International Inc).&#xD;
      We plan to use to this test in this study to estimate the prevalence of scrub typhus in&#xD;
      selected febrile patients presenting to clinics in Myanmar .&#xD;
&#xD;
      Patients will be followed up for one week to check for resolution of symptoms.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Title: A multicenter observational study to describe the prevalence of scrub typhus defined&#xD;
      as s positive rapid diagnostic test among selected patients presenting with fever to clinics&#xD;
      in Myanmar.&#xD;
&#xD;
      Rational and objectives of the study Fever is one of most common presenting complaints in&#xD;
      clinics in tropical countries. Rickettsial infections, enteric fever and leptospirosis are&#xD;
      common and important causes of undifferentiated fever in Southeast Asia. The largest and&#xD;
      earliest reports of scrub typhus in Myanmar were made during World War II when this disease&#xD;
      afflicted numerous troops, particularly those serving close to the border with India. Scrub&#xD;
      typhus is caused by Orientia tsutsugamushi and humans are typically infected by a bite of an&#xD;
      infected chigger (trombiculid mite larva). Clinical diagnosis is unreliable for identifying&#xD;
      scrub typhus, unless a tick eschar is present which is almost pathognomonic for the disease&#xD;
      in Southeast Asia. A combination of culture, paired serology and PCR has been proposed as the&#xD;
      gold-standard method for detection. As a result laboratory confirmation is not widely&#xD;
      available and the diagnosis is missed frequently in clinical practice. Some progress has been&#xD;
      made in developing such a test and one promising candidate is the Scrub Typhus Detect IgM&#xD;
      Rapid Test (InBios International Inc). In laboratory-based evaluations using stored sera&#xD;
      collected from patients recruited in a study in Thailand with confirmed scrub typhus this&#xD;
      test had a sensitivity of ~80% for the detection of the disease compared to serological&#xD;
      methods. We plan to use to this test in this study to estimate the prevalence of scrub typhus&#xD;
      in selected febrile patients presenting to clinics in Myanmar.&#xD;
&#xD;
      Primary objective: To describe the prevalence of scrub typhus defined as a positive rapid&#xD;
      diagnostic test among selected patients presenting with fever to clinics in Myanmar&#xD;
&#xD;
      Secondary objective:&#xD;
&#xD;
        -  To assess inter-observer agreement when interpreting the tests&#xD;
&#xD;
        -  To assess the ease-of-use of the tests&#xD;
&#xD;
        -  To direct future research efforts into rickettsial disease in Myanmar&#xD;
&#xD;
        -  To raise awareness of the presence of scrub typhus in Myanmar Inclusion criteria&#xD;
&#xD;
             1. Male or female &gt;1 year of age&#xD;
&#xD;
             2. Fever defined as &gt; 38 °C tympanic temperature&#xD;
&#xD;
             3. Duration of fever &gt;48h&#xD;
&#xD;
             4. Written informed consent (by legally acceptable representative in case of&#xD;
                children), and assent for children age 10-17 year&#xD;
&#xD;
             5. Eschar (60 patients only) Exclusion criteria&#xD;
&#xD;
        -  Malaria confirmed by RTD or microscopy&#xD;
&#xD;
        -  Skin/soft tissue infection, dysentery or urinary tract infection probable cause of fever&#xD;
&#xD;
      Procedures and Methodology The study will be carried out to describe the prevalence of scrub&#xD;
      typhus defined as a positive rapid diagnostic test among patients presenting with fever to&#xD;
      six participating clinics in Myanmar.&#xD;
&#xD;
      Patients coming with fever to participating clinics will be routinely assessment by attending&#xD;
      physician. Patients meeting the inclusion and exclusion criteria for the study will be&#xD;
      invited and enrolled to the study after getting informed consent.&#xD;
&#xD;
      Rapid diagnostic test and laboratory procedure A scrub typhus rapid test will be performed on&#xD;
      site by using the InBios Scrub Typhus Detect IgM Rapid Test. Tests will be read by two&#xD;
      independent readers and results recorded as positive, negative or invalid. In case of invalid&#xD;
      test result, another test will be performed using a new test strip. If there is any&#xD;
      disagreement between two readers, the lead investigator at the site will decide the test&#xD;
      result and the test will be photographed.&#xD;
&#xD;
      In patients with a skin eschar a sterile surgical blade will be used to gently scrape the&#xD;
      surface of the eschar. Scrapings will be stored in a cryotube containing 95% ethanol and&#xD;
      stored at -80°C for future analysis (PCR genotyping ± whole genome sequencing) to confirm the&#xD;
      presence of Orientia tsutsugamushi.&#xD;
&#xD;
      Treatment Physicians will be advised to formulate a treatment plan according to their usual&#xD;
      practice but it will be recommended that treatment for scrub typhus be added to the regimen&#xD;
      if the test is positive i.e. doxycycline 100mg bd for seven days in adults or 4mg/kg day in&#xD;
      two divided doses in children older than eight years. Doxycycline is contraindicated in&#xD;
      pregnant women and children eight years old or below and these groups should be prescribed&#xD;
      azithromycin (500mg single dose).&#xD;
&#xD;
      Follow up Patients will be reassessed at one week to check for resolution of fever and&#xD;
      symptoms . Any patient with ongoing symptoms will be re-assessed by a physician.&#xD;
&#xD;
      Duration and Study Sites Patients will be recruited 1 year starting from December 2017 to&#xD;
      November 2018 in six sites: Yae township hospital, No.2, 1000 Bedded Military Hospital (Nay&#xD;
      Pyi Taw), No.20, 100 Bedded Military Hospital (Tha Beik Kyin), NAP-MAM clinics (Kawkareik and&#xD;
      Putao township), No.2, 300 Bedded Military Hospital (Ann, Rakhine State).&#xD;
&#xD;
      Risk and benefits This is a low risk study. Finger prick for RDT and scrapping from eschar&#xD;
      (for patients who have eschar) may cause slight discomfort. Some patients may receive&#xD;
      antibiotics they would not have otherwise been prescribed as a result of having the test.&#xD;
      However this is most likely to benefit them as these tests have been shown to be sensitive&#xD;
      and specific for the diagnosis of scrub typhus in similar settings.&#xD;
&#xD;
      Incentives and Compensation There will be no incentives or compensation for study&#xD;
      participation. Confidentiality The study will ensure that the participants' anonymity is&#xD;
      maintained. The participants will be identified only by initials and a study number on the&#xD;
      CRF and the study database.&#xD;
&#xD;
      Publication The research findings will be disseminated to policy-makers and other interested&#xD;
      parties inside Myanmar. If there are any publications resulting from the results all those&#xD;
      who have made a substantial contribution will be co-authors.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date type="Actual">December 4, 2017</start_date>
  <completion_date type="Actual">December 26, 2019</completion_date>
  <primary_completion_date type="Actual">December 26, 2019</primary_completion_date>
  <study_type>Observational</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <observational_model>Other</observational_model>
    <time_perspective>Prospective</time_perspective>
  </study_design_info>
  <primary_outcome>
    <measure>Positive RDT Result</measure>
    <time_frame>15 Minutes</time_frame>
    <description>Proportion of patients with a positive RDT result</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Inter-observer agreement expressed as the kappa statistic</measure>
    <time_frame>15 Minutes</time_frame>
    <description>Ease- of- use of the test (scored on blood safety, quality of instructions, number of timed steps to perform test, ease of interpretation, user satisfaction)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Fever/symptom resolution</measure>
    <time_frame>One Week</time_frame>
    <description>Proportion of patients with fever/symptom resolution at one week</description>
  </secondary_outcome>
  <enrollment type="Actual">136</enrollment>
  <condition>The Prevalence of Scrub Typhus</condition>
  <intervention>
    <intervention_type>Diagnostic Test</intervention_type>
    <intervention_name>Scrub Typhus RDT Test</intervention_name>
    <description>A transfer pipette or loop will be used to transfer 10 µL of whole blood from a finger prick to the sample pad area on the scrub typhus test strip and the test will be performed on site according to the manufacturer's instructions. Tests will be read by two independent readers and results recorded as positive, negative or invalid.&#xD;
In patients with a skin eschar a sterile surgical blade will be used to gently scrape the surface of the eschar. Scrapings will be stored in a cryotube containing 95% ethanol and stored at -80°C for future analysis (PCR genotyping ± whole genome sequencing) to confirm the presence of Orientia tsutsugamushi.</description>
  </intervention>
  <eligibility>
    <study_pop>
      <textblock>
        Patients with fever (± eschar) presenting to community health clinics/hospitals in Myanmar&#xD;
      </textblock>
    </study_pop>
    <sampling_method>Probability Sample</sampling_method>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          1. Male or female &gt;1 year of age&#xD;
&#xD;
          2. Fever defined as &gt; 38 °C tympanic temperature&#xD;
&#xD;
          3. Duration of fever (self-reported) &gt;48h&#xD;
&#xD;
          4. Written informed consent (by parent or legally acceptable representative in case of&#xD;
             children), and assent for children aged 10-17 years&#xD;
&#xD;
          5. Eschar (60 patients only)&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          1. Malaria confirmed by RDT or microscopy&#xD;
&#xD;
          2. Skin/soft tissue infection, dysentery or urinary tract infection probable cause of&#xD;
             fever&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>1 Year</minimum_age>
    <maximum_age>N/A</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Elizabeth Anne Ashley, Dr</last_name>
    <role>Study Director</role>
    <affiliation>Myanmar Oxford Clinical Research Unit</affiliation>
  </overall_official>
  <overall_official>
    <last_name>Ni Ni Tun, Dr</last_name>
    <role>Study Director</role>
    <affiliation>Medical Action Myanmar</affiliation>
  </overall_official>
  <overall_official>
    <last_name>Aye Thida Aye, Dr</last_name>
    <role>Study Director</role>
    <affiliation>Yae Township Hospital, Mon State</affiliation>
  </overall_official>
  <overall_official>
    <last_name>Kyaw Myo Tun, Dr</last_name>
    <role>Study Director</role>
    <affiliation>Defence Services Medical Academy (DSMA)</affiliation>
  </overall_official>
  <overall_official>
    <last_name>Khine Khine Su, Prof</last_name>
    <role>Study Director</role>
    <affiliation>Defence Services Medical Academy (DSMA)</affiliation>
  </overall_official>
  <overall_official>
    <last_name>James Heaton, Dr</last_name>
    <role>Study Director</role>
    <affiliation>Myanmar Oxford Clinical Research Unit</affiliation>
  </overall_official>
  <overall_official>
    <last_name>Kyaw Soe</last_name>
    <role>Study Director</role>
    <affiliation>Myanmar Oxford Clinical Research Unit</affiliation>
  </overall_official>
  <overall_official>
    <last_name>Daniel Paris, Prof</last_name>
    <role>Study Director</role>
    <affiliation>Swiss Tropical &amp; Public Health Institute</affiliation>
  </overall_official>
  <overall_official>
    <last_name>Frank Smithuis, Prof</last_name>
    <role>Principal Investigator</role>
    <affiliation>Myanmar Oxford Clinical Research Unit and Medical Action Myanmar</affiliation>
  </overall_official>
  <overall_official>
    <last_name>Myo Mg Mg Swe, Dr</last_name>
    <role>Study Director</role>
    <affiliation>Myanmar Oxford Clinical Research Unit</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>No.20, 100 Bedded Military Hospital,</name>
      <address>
        <city>Thabeikkyin</city>
        <state>Mandalay</state>
        <country>Myanmar</country>
      </address>
    </facility>
  </location>
  <location>
    <facility>
      <name>No.2, 1000 Bedded Military Hospital</name>
      <address>
        <city>Nay Pyi Taw</city>
        <country>Myanmar</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>Myanmar</country>
  </location_countries>
  <verification_date>January 2019</verification_date>
  <study_first_submitted>August 29, 2017</study_first_submitted>
  <study_first_submitted_qc>August 29, 2017</study_first_submitted_qc>
  <study_first_posted type="Actual">August 31, 2017</study_first_posted>
  <last_update_submitted>January 9, 2020</last_update_submitted>
  <last_update_submitted_qc>January 9, 2020</last_update_submitted_qc>
  <last_update_posted type="Actual">January 13, 2020</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor</responsible_party_type>
  </responsible_party>
  <keyword>Scrub Typhus</keyword>
  <keyword>Positive Rapid Diagnostic Test</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Typhus, Epidemic Louse-Borne</mesh_term>
    <mesh_term>Scrub Typhus</mesh_term>
  </condition_browse>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03269266
org study id: OXTREC 18-17
nct id: NCT03269266
lead sponsor: 
collaborator: 
collaborator: 
collaborator: 
collaborator: 
collaborator: 
has dmc: No
is fda regulated drug: No
is fda regulated device: No
Fever is one of most common presenting complaints in clinics in tropical countries.
      Rickettsial infections, enteric fever and leptospirosis are common and important causes of
      undifferentiated fever in Southeast Asia. Scrub typhus is caused by Orientia tsutsugamushi
      and humans are typically infected by a bite of an infected chigger (trombiculid mite larva).
      Clinical diagnosis is unreliable for identifying scrub typhus, unless a tick eschar is
      present which is almost pathognomonic for the disease in Southeast Asia. A combination of
      culture, paired serology and PCR has been proposed as the gold-standard method for detection.
      As a result laboratory confirmation is not widely available and the diagnosis is missed
      frequently in clinical practice. Some progress has been made in developing such a test and
      one promising candidate is the Scrub Typhus Detect IgM Rapid Test (InBios International Inc).
      We plan to use to this test in this study to estimate the prevalence of scrub typhus in
      selected febrile patients presenting to clinics in Myanmar .

      Patients will be followed up for one week to check for resolution of symptoms.
Title: A multicenter observational study to describe the prevalence of scrub typhus defined
      as s positive rapid diagnostic test among selected patients presenting with fever to clinics
      in Myanmar.

      Rational and objectives of the study Fever is one of most common presenting complaints in
      clinics in tropical countries. Rickettsial infections, enteric fever and leptospirosis are
      common and important causes of undifferentiated fever in Southeast Asia. The largest and
      earliest reports of scrub typhus in Myanmar were made during World War II when this disease
      afflicted numerous troops, particularly those serving close to the border with India. Scrub
      typhus is caused by Orientia tsutsugamushi and humans are typically infected by a bite of an
      infected chigger (trombiculid mite larva). Clinical diagnosis is unreliable for identifying
      scrub typhus, unless a tick eschar is present which is almost pathognomonic for the disease
      in Southeast Asia. A combination of culture, paired serology and PCR has been proposed as the
      gold-standard method for detection. As a result laboratory confirmation is not widely
      available and the diagnosis is missed frequently in clinical practice. Some progress has been
      made in developing such a test and one promising candidate is the Scrub Typhus Detect IgM
      Rapid Test (InBios International Inc). In laboratory-based evaluations using stored sera
      collected from patients recruited in a study in Thailand with confirmed scrub typhus this
      test had a sensitivity of ~80% for the detection of the disease compared to serological
      methods. We plan to use to this test in this study to estimate the prevalence of scrub typhus
      in selected febrile patients presenting to clinics in Myanmar.

      Primary objective: To describe the prevalence of scrub typhus defined as a positive rapid
      diagnostic test among selected patients presenting with fever to clinics in Myanmar

      Secondary objective:

        -  To assess inter-observer agreement when interpreting the tests

        -  To assess the ease-of-use of the tests

        -  To direct future research efforts into rickettsial disease in Myanmar

        -  To raise awareness of the presence of scrub typhus in Myanmar Inclusion criteria

             1. Male or female >1 year of age

             2. Fever defined as > 38 °C tympanic temperature

             3. Duration of fever >48h

             4. Written informed consent (by legally acceptable representative in case of
                children), and assent for children age 10-17 year

             5. Eschar (60 patients only) Exclusion criteria

        -  Malaria confirmed by RTD or microscopy

        -  Skin/soft tissue infection, dysentery or urinary tract infection probable cause of fever

      Procedures and Methodology The study will be carried out to describe the prevalence of scrub
      typhus defined as a positive rapid diagnostic test among patients presenting with fever to
      six participating clinics in Myanmar.

      Patients coming with fever to participating clinics will be routinely assessment by attending
      physician. Patients meeting the inclusion and exclusion criteria for the study will be
      invited and enrolled to the study after getting informed consent.

      Rapid diagnostic test and laboratory procedure A scrub typhus rapid test will be performed on
      site by using the InBios Scrub Typhus Detect IgM Rapid Test. Tests will be read by two
      independent readers and results recorded as positive, negative or invalid. In case of invalid
      test result, another test will be performed using a new test strip. If there is any
      disagreement between two readers, the lead investigator at the site will decide the test
      result and the test will be photographed.

      In patients with a skin eschar a sterile surgical blade will be used to gently scrape the
      surface of the eschar. Scrapings will be stored in a cryotube containing 95% ethanol and
      stored at -80°C for future analysis (PCR genotyping ± whole genome sequencing) to confirm the
      presence of Orientia tsutsugamushi.

      Treatment Physicians will be advised to formulate a treatment plan according to their usual
      practice but it will be recommended that treatment for scrub typhus be added to the regimen
      if the test is positive i.e. doxycycline 100mg bd for seven days in adults or 4mg/kg day in
      two divided doses in children older than eight years. Doxycycline is contraindicated in
      pregnant women and children eight years old or below and these groups should be prescribed
      azithromycin (500mg single dose).

      Follow up Patients will be reassessed at one week to check for resolution of fever and
      symptoms . Any patient with ongoing symptoms will be re-assessed by a physician.

      Duration and Study Sites Patients will be recruited 1 year starting from December 2017 to
      November 2018 in six sites: Yae township hospital, No.2, 1000 Bedded Military Hospital (Nay
      Pyi Taw), No.20, 100 Bedded Military Hospital (Tha Beik Kyin), NAP-MAM clinics (Kawkareik and
      Putao township), No.2, 300 Bedded Military Hospital (Ann, Rakhine State).

      Risk and benefits This is a low risk study. Finger prick for RDT and scrapping from eschar
      (for patients who have eschar) may cause slight discomfort. Some patients may receive
      antibiotics they would not have otherwise been prescribed as a result of having the test.
      However this is most likely to benefit them as these tests have been shown to be sensitive
      and specific for the diagnosis of scrub typhus in similar settings.

      Incentives and Compensation There will be no incentives or compensation for study
      participation. Confidentiality The study will ensure that the participants' anonymity is
      maintained. The participants will be identified only by initials and a study number on the
      CRF and the study database.

      Publication The research findings will be disseminated to policy-makers and other interested
      parties inside Myanmar. If there are any publications resulting from the results all those
      who have made a substantial contribution will be co-authors.
observational model: Other
time perspective: Prospective
measure: Positive RDT Result
time frame: 15 Minutes
description: Proportion of patients with a positive RDT result
measure: Inter-observer agreement expressed as the kappa statistic
time frame: 15 Minutes
description: Ease- of- use of the test (scored on blood safety, quality of instructions, number of timed steps to perform test, ease of interpretation, user satisfaction)
measure: Fever/symptom resolution
time frame: One Week
description: Proportion of patients with fever/symptom resolution at one week
intervention type: Diagnostic Test
intervention name: Scrub Typhus RDT Test
description: A transfer pipette or loop will be used to transfer 10 µL of whole blood from a finger prick to the sample pad area on the scrub typhus test strip and the test will be performed on site according to the manufacturer's instructions. Tests will be read by two independent readers and results recorded as positive, negative or invalid.
In patients with a skin eschar a sterile surgical blade will be used to gently scrape the surface of the eschar. Scrapings will be stored in a cryotube containing 95% ethanol and stored at -80°C for future analysis (PCR genotyping ± whole genome sequencing) to confirm the presence of Orientia tsutsugamushi.
study pop: 
sampling method: Probability Sample
criteria: 
gender: All
minimum age: 1 Year
maximum age: N/A
healthy volunteers: No
last name: Elizabeth Anne Ashley, Dr
role: Study Director
affiliation: Myanmar Oxford Clinical Research Unit
last name: Ni Ni Tun, Dr
role: Study Director
affiliation: Medical Action Myanmar
last name: Aye Thida Aye, Dr
role: Study Director
affiliation: Yae Township Hospital, Mon State
last name: Kyaw Myo Tun, Dr
role: Study Director
affiliation: Defence Services Medical Academy (DSMA)
last name: Khine Khine Su, Prof
role: Study Director
affiliation: Defence Services Medical Academy (DSMA)
last name: James Heaton, Dr
role: Study Director
affiliation: Myanmar Oxford Clinical Research Unit
last name: Kyaw Soe
role: Study Director
affiliation: Myanmar Oxford Clinical Research Unit
last name: Daniel Paris, Prof
role: Study Director
affiliation: Swiss Tropical & Public Health Institute
last name: Frank Smithuis, Prof
role: Principal Investigator
affiliation: Myanmar Oxford Clinical Research Unit and Medical Action Myanmar
last name: Myo Mg Mg Swe, Dr
role: Study Director
affiliation: Myanmar Oxford Clinical Research Unit
facility: 
facility: 
country: Myanmar
responsible party type: Sponsor
mesh term: Typhus, Epidemic Louse-Borne
mesh term: Scrub Typhus