Rickettsiosis Infections in Sarawak: Epidemiological Insights and Public Health Strategies.

Rickettsiosis infections pose a significant public health concern in Sarawak, Malaysia. Despite their importance, these infections remain poorly recognised, under-researched and inadequately documented within the context of the Sarawak region. This comprehensive evaluation seeks to address this knowledge gap by providing an in-depth analysis of Rickettsioses in Sarawak, focussing on four main aspects: the vectors and reservoirs of Rickettsioses, transmission dynamics and risk factors, existing challenges and public health implications and control strategies and future directions for raising awareness. Between 2013 and 2023, eleven Rickettsiosis cases were reported across seven districts in Sarawak. Three Rickettsial groups, namely, spotted fever group, typhus group and scrub typhus, have been identified in the region and linked to their respective arthropod vectors and vertebrate reservoirs. Although the overall number of confirmed Rickettsial infections in Sarawak remains relatively low, the detection of cases in both urban centres and smaller towns within rural areas raises concern regarding potential spread and under-recognition of these infections. This review underscores the urgent need to enhance regional awareness, strengthen disease surveillance and encourage focused research to bridge existing knowledge gaps. Developing evidence-based strategies for early detection, vector control and public health education will be crucial for preventing future outbreaks and safeguarding the health and well-being of communities throughout Sarawak.