Surveillance for scrub typhus was conducted in Japan in 1998 using a questionnaire. A total of 462 cases were reported. Scrub typhus occurred in both the fall and spring in the northern part of Honshu (the main island), and in the fall in the central part of Honshu and on the island of Kyushu. The occurrence of the disease varied with age, gender, and activity. Seventy-six percent of the patients were more than 51 years old, and 36% and 16% of the patients were engaged in farm work and forestry, respectively. Fever, rash, and eschar were detected in 98%, 93%, and 97% of the patients, respectively. Elevated levels of C-reactive protein, aspartate transaminase, and alanine transaminase were detected in 96%, 87%, and 77% of the patients, respectively. Disseminated intravascular coagulation developed in 34 cases and had a unique regional distribution. This study shows the status of scrub typhus in Japan in 1998 and provides important information for diagnosis and prevention.