Statement of PrinciplesconcerningSCRUB TYPHUS(Reasonable Hypothesis)(No. 68 of 2026)The Repatriation Medical Authority determines the following Statement of Principles under section 370CB of the Military Rehabilitation and Compensation Act 2004.Dated 19 October 2026Dr Anthony Lynham AOChairpersonby and on behalf ofThe Repatriation Medical AuthorityContents1 Name2 Commencement3 Authority4 Repeal5 Application6 Definitions7 Kind of injury, disease or death to which this Statement of Principles relates8 Basis for determining the factors9 Factors that must exist10 Relationship to service11 Factors referring to an injury or disease covered by another Statement of PrinciplesSchedule 1 - Dictionary1 DefinitionsNameThis is the Statement of Principles concerning scrub typhus (Reasonable Hypothesis) (No. 68 of 2026).CommencementThis instrument commences on 16 November 2026.AuthorityThis instrument is made under section 370CB of the Military Rehabilitation and Compensation Act 2004.RepealThe Statement of Principles concerning scrub typhus (Reasonable Hypothesis) (No. 77 of 2018) (Federal Register of Legislation No. F2018L01162) made under subsection 196B(2) of the VEA is repealed.ApplicationThis instrument applies to a claim to which section 338 of the Military Rehabilitation and Compensation Act 2004 applies.DefinitionsThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.This Statement of Principles is about scrub typhus and death from scrub typhus.Meaning of scrub typhusFor the purposes of this Statement of Principles, scrub typhus:means a clinical illness caused by infection with Orientia tsutsugamushi, Orientia chuto, or Orientia chiloensis;Note 1: The Orientia genus of bacteria contains three species, of which Orientia tsutsugamushi is the most common cause of scrub typhus.Note 2: Humans usually acquire the infection from the bite of an infected trombiculid mite (chigger).Note 3: Symptoms of scrub typhus include, but are not limited to, eschar at the bite site, high fever, headache, myalgia, cough, a rash, and lymphadenopathy.While scrub typhus attracts ICD 10 AM code A75.3, in applying this Statement of Principles the meaning of scrub typhus is that given in subsection (2).For subsection (3), a reference to an ICD-10-AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4.Death from scrub typhusFor the purposes of this Statement of Principles, scrub typhus, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's scrub typhus.Note: terminal event is defined in the Schedule 1 – Dictionary.Basis for determining the factorsThe Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that scrub typhus and death from scrub typhus can be related to relevant service under the MRCA.Note: MRCA and relevant service are defined in the Schedule 1 – Dictionary.Factors that must existAt least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting scrub typhus or death from scrub typhus with the circumstances of a person's relevant service:being bitten by a trombiculid mite (chigger) infected with Orientia species; orbeing in an area that is endemic for scrub typhus; orhaving percutaneous exposure to blood contaminated with Orientia species; orreceiving a blood transfusion, blood products or a stem cell transplant contaminated with Orientia species;within the 28 days before clinical onset;Note: Areas endemic for scrub typhus include Africa, the Middle East, South America, Islands of the Pacific, and the part of the world known as the "tsutsugamushi triangle" which extends from northern Japan and far-eastern Russia in the north, to northern Australia in the south, and Pakistan in the west.inability to obtain appropriate clinical management for scrub typhus before clinical worsening.The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person.The clinical worsening aspect of factors set out in section 9 apply only to material contribution to, or aggravation of, scrub typhus where the person's scrub typhus was suffered or contracted before or during (but did not arise out of) the person's relevant service.Factors referring to an injury or disease covered by another Statement of PrinciplesIn this Statement of Principles:if a factor referred to in section 9 applies in relation to a person; andthat factor refers to an injury or disease in respect of which a Statement of Principles has been determined under section 370CB of the MRCA;then the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.Schedule 1 - DictionaryNote: See Section 61 DefinitionsIn this instrument:MRCA means the Military Rehabilitation and Compensation Act 2004.relevant service means:(a) warlike service;(b) non-warlike service;(c) British nuclear test defence service;(d) hazardous service.scrub typhus—see subsection 7(2).terminal event means the proximate or ultimate cause of death and includes the following:(a) pneumonia;(b) respiratory failure;(c) cardiac arrest;(d) circulatory failure; or(e) cessation of brain function.