Progress in Treating a Neglected Tropical Disease

This editorial discusses the INTREST clinical trial evaluating intravenous azithromycin, doxycycline, and their combination for severe scrub typhus treatment. While mortality remained high across all arms (12.1%), combination therapy significantly reduced early complications. The authors emphasize the urgent need for rapid diagnostics—especially point-of-care tools—and enhanced prevention strategies. Despite scrub typhus’s growing global burden and the trial’s relevance across diverse strains and regions, the disease remains excluded from official neglected tropical disease lists. Challenges to vaccine development persist due to strain diversity, limited cross-protective immunity, and sparse research expertise. Authors call for expanded funding and attention to this “super-neglected” disease.

This editorial discusses the INTREST clinical trial evaluating intravenous azithromycin, doxycycline, and their combination for severe scrub typhus treatment. While mortality remained high across all arms (12.1%), combination therapy significantly reduced early complications. The authors emphasize the urgent need for rapid diagnostics—especially point-of-care tools—and enhanced prevention strategies. Despite scrub typhus’s growing global burden and the trial’s relevance across diverse strains and regions, the disease remains excluded from official neglected tropical disease lists. Challenges to vaccine development persist due to strain diversity, limited cross-protective immunity, and sparse research expertise. Authors call for expanded funding and attention to this “super-neglected” disease.