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Typhus is a disease caused by two different species of Rickettsia bacilli and associated with human crowding and poor sanitary conditions. Humans may contract two different types of typhus: Endemic or murine typhus, caused by R. typhi, which is transmitted by the rat flea; and epidemic typhus, caused by R. prowazekii, which is transmitted by the human body louse. Typhus causes very high fever, severe aches, delirium, vomiting, and a characteristic rash. Untreated, epidemic typhus presents a death rate of up to 60 percent; murine typhus is typically milder and less fatal.
Epidemic typhus has long been common in refugee camps, in times of war, in prisons, and after environmental disasters. Then called the “Hungarian disease,” typhus swept through central and western Europe during the Thirty Years’ War (1618-48); tens of thousands of civilians died in several German and French cities. During some wars in Europe, most famously the Napoleonic wars, typhus killed more soldiers and civilians than did warfare itself, leading some to claim for typhus a key role in history. Weakened from the potato famine and displaced from their communities, many Irish died of typhus in the 1840s. Between two and three million people died of typhus during World War I, primarily Polish, Romanian, and Russian soldiers and civilians; many more would have died had the louse vector not been discovered and delousing practices implemented. Thousands of prisoners in German concentration camps during World War II died of typhus.
Campaigns to prevent or eradicate typhus helped cement the role of DDT as a public health tool. Allied forces used DDT to kill lice during typhus outbreaks in Naples, Italy, in 1943. The exposure of residents to DDT on their clothing and skin has been cited as evidence of the chemical’s safety. The threat of murine typhus has also spurred public health agencies to initiate rodent control campaigns. Laborers in Depression-era work-relief programs in the United States killed millions of rats in Georgia, Mississippi, and Texas in an effort to stop the spread of murine typhus and prevent more infected rats from entering the country via seaports. Murine typhus persists in low levels throughout much of the southern United States.
Today, typhus may be treated with antibiotics, most effectively in murine typhus but also with considerable success in epidemic typhus. A vaccine for typhus has also been used to protect vulnerable populations. In recent years, however, epidemic typhus has appeared in refugee camps following wars or disasters when public health aid is unavailable or limited. International public health observers and disease surveillance agencies suspect that recent civil unrest, refugee movements, and environmental disasters have set the stage for increasingly severe typhus epidemics to reemerge among vulnerable populations. Some epidemiologists believe that louse infestations are increasing worldwide as a result of a web of deteriorating social, political, economic, and environmental conditions.
Poor hygiene in refugee camps presents the greatest concern, and high percentages of lice found there carry the Rickettsia that causes epidemic typhus. Since the 1970s, refugee camps in central and eastern Africa have suffered the most severe outbreaks of epidemic typhus. During the 1990s thousands of refugees in Rwanda, Burundi, and what was then Zaire suffered typhus epidemics. In 1997 Burundi experienced the largest typhus epidemic since World War II, with 24,000 cases. The World Health Organization and other public health groups controlled the outbreak by treating patients with the antibiotic doxycycline. Since 1995 smaller outbreaks have also been reported in Russia, Peru, and Algeria.
- Pierre-Edouard Fournier et , “Human Pathogens in Body and Head Lice,” Emerging Infectious Diseases (v.12, December 2002);
- William H. McNeill, Plagues and Peoples (Random House, 1976);
- Raoult and V. Roux, “The Body Louse as a Vector of Reemerging Human Diseases,” Clinical Infectious Diseases (v.29, October 1999);
- Hans Zinsser, Rats, Lice, and History (Little, Brown, 1934).