Although residents frequently move between the southwest islands and Echang, they seldom migrate from these areas to other hamlets in Koror.
tsutsugamushi, based on assessment of serum samples collected from southwest islands scrub typhus patients 5 months to 2 years after infection (Table 1).
During the investigation, 212 blood samples were collected from consenting residents of 88 households, including 22 households from the southwest islands, 29 households from Echang, and 37 households from other Koror hamlets.
Residents of the southwest islands and Echang did not differ significantly in seropositive status.
In the southwest islands, residents >18 years of age were significantly more likely to be seropositive than were children (RR 1.
8%) reported that they had not traveled to the southwest islands or other islands during the past 2 years.
In this outbreak of scrub typhus in the southwest islands of the Republic of Palau, abdominal distress was a prominent feature.
After this cluster of scrub typhus cases was recognized, a campaign to educate the local community about the disease was launched in the southwest islands and in the capitol.