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Article History

Received: 24 April 2025

Accepted: 30 August 2025

First Online: 4 September 2025

Declarations

:

: This was an observational study carried out with the purpose of describing the epidemiology of the disease and identifying the risk factors to guide appropriate public health measures as part of the public health response of the Sikkim State Health Department and NCDC. Ethical approval was exempted and not applicable, as the investigation was conducted as part of a public health response and consistent with applicable state and central government law (Epidemic Diseases Act no. 3, 1897). The study did not involve any human or animal laboratory sample collection for research purposes, or intervention. Strict data protection protocols reviewed by NCDC, ethical principles and guidelines by the Government of India, and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards were followed during data handling.

: Not applicable.

: Not applicable.

: The authors declare that they have no competing interests to declare that are relevant to the content of this article.