Objective To analyze the epidemiological characteristics of scrub typhus in China from 2006 to 2023, so as to provide scientific evidence for the prevention and control of scrub typhus．

Methods The data on scrub typhus from 2006 to 2023 was obtained from China's National Notifiable Infectious Disease Reporting Information System, and the spatiotemporal distribution, seasonal pattern and demographic features of cases were analyzed.

Results A total of 283273cases and 103 deaths were recorded. The average annual incidence was 1.14 cases/100 000 population during 2006−2023. The annual incidence increased sharply from 0.10/100 000 population in 2006 to 2.37/100 000 population in 2023. The number of affected counties or districts increased from 226 in 2006 to 1150 in 2023. The top five provinces by reported cases were Yunnan province (84795), Guangdong province (70013), Guangxi Zhuang Autonomous Region (30147), Anhui province (20492) and Jiangsu province (16760), which accounted for 78.44% of total cases of scrub typhus. The disease, historically endemic to southern China in 2006−2009, has expanded to all the provinces, especially in northernmost and western of China. The cases of scrub typhus occurs frequently from June to November (88.45%). The seasonal index was the highest in October (2.5) followed by July-August. Females (52.90%), farmers (76.11%) and aged 40-59 years (39.98%) were the main affected groups, and the proportion of cases aged 60 and above increased from 22.83% in 2006 to 37.90% in 2023.

Conclusion The incidence rates of scrub typhus increased in an unprecedented trend in China and the geographic distribution document an expansion throughout the country, especially in northernmost and western of China. The main vulnerable groups are middle-aged and elderly farmers. The changes of epidemiological characteristics highlight the need to adjust and enhance current disease prevention and control strategies. It is necessary to strengthen the surveillance and promote health education in people living in epidemic areas of China, especially elderly people and those working in agricultural settings. The knowledge awareness rate should be improved so as to reduce the disease burden of scrub typhus.