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Yearly occurrence of Seasonal Hyperacute Panuveitis (SHAPU) outbreaks in Nepal matches the emergence of its causal agent, the moth Gazalina chrysolopha

ecosystem-science
entomology
ophthalmology
environmental-health

Abstract

Background

The Seasonal Hyperacute Panuveitis (SHAPU) generally occurs in odd-numbered years across Nepal, and it is associated with exposure to the causal agent, the urticating setae released by the female moths of Gazalina chrysolopha (Lepidoptera, Notodontidae) in the season following the monsoon. This study reports on an outbreak observed in 2024, an even-numbered year that deviates from the expectation.

Methods

A prospective, hospital-based study was conducted on all patients diagnosed with SHAPU in 2024 in a few tertiary-level Nepali eye hospitals based in Kathmandu and Pokhara. Data were collected on patient demographics, geographical distribution, and clinical characteristics. Data on seasonal insect occurrence in even- and odd-numbered years were collected for Nepal from databases and museum collections for a total of 1693 records.

Results

A total of 18 patients were diagnosed with SHAPU in 2024. The outbreak was observed to spread beyond the typical hotspots of the disease in Nepal. The patients’ ages ranged from 2 to 56, with 8 (44.44%) being under 18 years. Patients reported direct or indirect contact with moths and their caterpillars, and the cases were observed between January and June, with a peak in May. The period matches the emergence of the moth in even-numbered years, while in odd-numbered years, the emergence peaks between July and September, as in the SHAPU cases.

Conclusions

The outbreak of SHAPU in 2024 suggests a shift in its typical pattern, raising concerns that the disease may become an annual occurrence, as evidenced by the few cases observed in 2020 and 2022, in contrast to the expected outbreaks in odd-numbered years (2019, 2021, and 2023). The moths of Gazalina chrysolopha emerged earlier in even-numbered years, explaining the earlier occurrence of SHAPU cases. The spread of SHAPU to other parts of Nepal suggests the possibility that the disease may be becoming a major risk throughout the country.

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