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Epidemic typhus, also known as louse-borne typhus, is a form of typhus so named because the disease often causes following wars and natural disasters where civil life is disrupted. (2025). 9789401798754, Springer, Dordrecht. ISBN 9789401798754 Epidemic typhus is spread to people through contact with infected Body Lice, in contrast to endemic typhus which is usually transmitted by .
Though typhus has been responsible for millions of deaths throughout history, it is still considered a rare disease that occurs mainly in populations that suffer unhygienic extreme overcrowding. Typhus is most rare in industrialized countries. It occurs primarily in the colder, mountainous regions of central and east Africa, as well as Central and South America. The causative organism is Rickettsia prowazekii, transmitted by the human body louse ( Pediculus humanus corporis). Untreated typhus cases have a fatality rate of approximately 40%.
Epidemic typhus should not be confused with murine typhus, which is more endemic to the United States, particularly Southern California and Texas. This form of typhus has similar symptoms but is caused by Rickettsia typhi, is less deadly, and has different vectors for transmission.
After 5–6 days, a macular skin eruption develops: first on the upper trunk and spreading to the rest of the body (rarely to the face, palms, or soles of the feet, however).
Brill–Zinsser disease, first described by Nathan Brill in 1913 at Mount Sinai Hospital in New York City, is a mild form of epidemic typhus that recurs in someone after a long period of latency (similar to the relationship between chickenpox and shingles). This recurrence often arises in times of relative immunosuppression, which is often in the context of a person suffering malnutrition or other illnesses. In combination with poor sanitation and hygiene in times of social chaos and upheaval, which enable a greater density of lice, this reactivation is why typhus generates epidemics in such conditions.
Epidemic typhus has historically occurred during times of war and deprivation. For example, typhus killed millions of prisoners in German Nazi Germany concentration camps during World War II. The unhygenic conditions in camps such as Auschwitz, Theresienstadt, and Bergen-Belsen allowed diseases such as typhus to flourish. Situations in the twenty-first century with potential for a typhus epidemic would include refugee camps during a major famine or natural disaster. In the periods between outbreaks, when human to human transmission occurs less often, the flying squirrel serves as a zoonotic reservoir for the Rickettsia prowazekii bacterium.
In 1916, Henrique da Rocha Lima proved that the bacterium Rickettsia prowazekii was the agent responsible for typhus. He named it after his colleague Stanislaus von Prowazek, who had along with himself become infected with typhus while investigating an outbreak, subsequently dying, and H. T. Ricketts, another zoologist who had died from typhus while investigating it. Once these crucial facts were recognized, Rudolf Weigl in 1930 was able to fashion a practical and effective vaccine production method. He ground up the insides of infected lice that had been drinking blood. It was, however, very dangerous to produce, and carried a high likelihood of infection to those who were working on it.
A safer mass production-ready method using was developed by Herald R. Cox in 1938. This vaccine was widely available and used extensively by 1943.
Some of the simplest methods of prevention and treatment focus on preventing infestation of body lice. Completely changing the clothing, washing the infested clothing in hot water, and in some cases also treating recently used bedsheets all help to prevent typhus by removing potentially infected lice. Clothes left unworn and unwashed for 7 days also result in the death of both lice and their eggs, as they have no access to a human host. Another form of lice prevention requires dusting infested clothing with a powder consisting of 10% DDT, 1% malathion, or 1% permethrin, which kill lice and their eggs.
Other preventive measures for individuals are to avoid unhygienic, extremely overcrowded areas where the causative organisms can jump from person to person. In addition, they are warned to keep a distance from larger rodents that carry lice, such as rats, squirrels, or opossums.
The first description of typhus was probably given in 1083 at La Cava abbey near Salerno, Italy. In 1546, Girolamo Fracastoro, a Florence physician, described typhus in his famous treatise on viruses and contagion, De Contagione et Contagiosis Morbis.
Typhus was carried to mainland Europe by soldiers who had been fighting on Cyprus. The first reliable description of the disease appears during the siege of the Emirate of Granada by the Catholic Monarchs in 1489 during the Granada War. These accounts include descriptions of fever and red spots over arms, back and chest, progressing to delirium, gangrenous sores, and the stench of rotting flesh. During the siege, the Catholics lost 3,000 men to enemy action, but an additional 17,000 died of typhus.
Typhus was also common in prisons (and in crowded conditions where lice spread easily), where it was known as Gaol fever or Jail fever. Gaol fever often occurs when prisoners are frequently huddled together in dark, filthy rooms. Imprisonment until the next term of court was often equivalent to a death sentence. Typhus was so infectious that prisoners brought before the court sometimes infected the court itself. Following the Black Assize of Oxford 1577, over 510 died from epidemic typhus, including Speaker Robert Bell, Lord Chief Baron of the Exchequer. The outbreak that followed, between 1577 and 1579, killed about 10% of the English people.
During the assizes held at Taunton (1730), typhus caused the death of the Lord Chief Baron of the Exchequer, the High Sheriff of Somerset, the sergeant, and hundreds of other persons. During a time when there were 241 capital offences, more prisoners died from 'gaol fever' than were put to death by all the public executioners in the realm. In 1759 an English authority estimated that each year a quarter of the prisoners had died from gaol fever.Ralph D. Smith, "Comment, Criminal Law – Arrest – The Right to Resist Unlawful Arrest," 7 Nat. Resources J. 119, 122 n.16 (1967) (hereinafter Comment) (citing John Howard, The State of Prisons 6-7 (1929)) (Howard's observations are from 1773 to 1775). Copied from State v. Valentine, May 1997 132 Wn.2d 1, 935 P.2d 1294 In London, typhus frequently broke out among the ill-kept prisoners of Newgate Gaol and moved into the general city population.
In the United States, a typhus epidemic struck Philadelphia in 1837. The son of Franklin Pierce died in 1843 of a typhus epidemic in Concord, New Hampshire. Several epidemics occurred in Baltimore, Memphis, and Washington, D.C. between 1865 and 1873. Typhus fever was also a significant killer during the American Civil War, although typhoid fever was the more prevalent cause of US Civil War "camp fever." Typhoid is a completely different disease from typhus. Typically more men died on both sides of disease than wounds.
Rudolph Carl Virchow, a physician, anthropologist, and historian attempted to control an outbreak of typhus in Upper Silesia and wrote a 190-page report about it. He concluded that the solution to the outbreak did not lie in individual treatment or by providing small changes in housing, food or clothing, but rather in widespread structural changes to directly address the issue of poverty. Virchow's experience in Upper Silesia led to his observation that "Medicine is a social science". His report led to changes in German public health policy.
Following the development of a vaccine during World War II, Western Europe and North America have been able to prevent epidemics. These have usually occurred in Eastern Europe, the Middle East, and parts of Africa, particularly Ethiopia. Naval Medical Research Unit Five worked there with the government on research to attempt to eradicate the disease.
In one of its first major outbreaks since World War II, epidemic typhus reemerged in 1995 in a jail in N'Gozi, Burundi. This outbreak followed the start of the Burundian Civil War in 1993, which caused the displacement of 760,000 people. Refugee camps were crowded and unsanitary, and often far from towns and medical services.
Attempts to create a living vaccine of classical, louse-borne, typhus were attempted by French researchers but these proved unsuccessful. Researchers turned to murine typhus to develop a live vaccine. At the time, murine vaccine was viewed as a less severe alternative to classical typhus. Four versions of a live vaccine cultivated from murine typhus were tested, on a large scale, in 1934.
While the French were making advancements with live vaccines, other European countries were working to develop killed vaccines. During World War II, there were three kinds of potentially useful killed vaccines. All three killed vaccines relied on the cultivation of Rickettsia prowazekii, the organism responsible for typhus. The first attempt at a killed vaccine was developed by Germany, using the Rickettsia prowazekii found in louse feces. The vaccine was tested extensively in Poland between the two world wars and used by the Germans for their troops during their attacks on the Soviet Union.
A second method of growing Rickettsia prowazekii was discovered using the yolk sac of chick embryos. Germans tried several times to use this technique of growing Rickettsia prowazekii but no effort was pushed very far.
The last technique was an extended development of the previously known method of growing murine typhus in rodents. It was discovered that rabbits could be infected, by a similar process, and contract classical typhus instead of murine typhus. Again, while proven to produce suitable Rickettsia prowazekii for vaccine development, this method was not used to produce wartime vaccines.
During WWII, the two major vaccines available were the killed vaccine grown in lice and the live vaccine from France. Neither was used much during the war. The killed, louse-grown vaccine was difficult to manufacture in large enough quantities, and the French vaccine was not believed to be safe enough for use.
The Germans worked to develop their own live vaccine from the urine of typhus victims. While developing a live vaccine, Germany used live Rickettsia prowazekii to test multiple possible vaccines' capabilities. They gave live Rickettsia prowazekii to concentration camp prisoners, using them as a control group for the vaccine tests.
The use of DDT as an effective means of killing lice, the main carrier of typhus, was discovered in Naples.
Typhus has been increasingly discovered in homeless populations in developed nations. Typhus among homeless populations is especially prevalent as these populations tend to migrate across states and countries, spreading the risk of infection with their movement. The same risk applies to , who travel across country lines, often living in close proximity and unable to maintain necessary hygienic standards to avoid being at risk for catching lice possibly infected with typhus.
Because the typhus-infected lice live in clothing, the prevalence of typhus is also affected by weather, humidity, poverty and lack of hygiene. Lice, and therefore typhus, are more prevalent during colder months, especially winter and early spring. In these seasons, people tend to wear multiple layers of clothing, giving lice more places to go unnoticed by their hosts. This is particularly a problem for poverty-stricken populations as they often do not have multiple sets of clothing, preventing them from practicing good hygiene habits that could prevent louse infestation.
Due to fear of an outbreak of epidemic typhus, the US Government put a typhus quarantine in place in 1917 across the entirety of the US-Mexican border. Sanitation plants were constructed that required immigrants to be thoroughly inspected and bathed before crossing the border. Those who routinely crossed back and forth across the border for work were required to go through the sanitation process weekly, updating their quarantine card with the date of the next week's sanitation. These sanitation border stations remained active over the next two decades, regardless of the disappearance of the typhus threat. This fear of typhus and resulting quarantine and sanitation protocols dramatically hardened the border between the US and Mexico, fostering scientific and popular prejudices against Mexicans. This ultimately intensified racial tensions and fueled efforts to ban immigrants to the US from the Southern Hemisphere because the immigrants were associated with the disease.
55. ↑ Alice S. Chapman (2006). "Cluster of Sylvatic Epidemic Typhus Cases Associated with Flying Squirrels, 2004 - 2006" MedscapeCME Epidemic Typhus Associated with Flying Squirrels – United States
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