Typhus Control Research Articles

Development and implementation of a strategy for early diagnosis and management of scrub typhus: an emerging public health threat.

Scrub typhus, caused by Orientia tsutsugamushi, is a re-emerging zoonotic disease in the tropics with considerable morbidity and mortality rates. This disease, which is mostly prevalent in rural areas, remains underdiagnosed and underreported because of the low index of suspicion and non-specific clinical presentation. Limited access to healthcare, diagnostics, and treatment in rural settings further makes it challenging to distinguish it from other febrile illnesses. While easily treatable, improper treatment leads to severe forms of the disease and even death. As there is no existing public health program to address scrub typhus in India, there is an urgent need to design a program and test its effectiveness for control and management of the disease. With this backdrop, this implementation research protocol has been developed for a trial in few of the endemic "pockets" of Odisha, an eastern Indian state that can be scalable to other endemic areas of the country, if found effective. The main goal of the proposed project is to include scrub typhus as a differential diagnosis of fever cases in every tier of the public health system, starting from the community level to the health system, for the early diagnosis among suspected cases and to ensure that individuals receive complete treatment. The current study aimed to describe the protocol of the proposed Scrub Typhus Control Program (STCP) in detail so that it can receive valuable views from peers which can further strengthen the attempt.

Epidemiological characteristics of typhus in China, 1950-2021

Objective: To analyze the epidemiological characteristics of typhus in China from 1950 to 2021, and discuss the challenges in typhus prevention and control in China and suggest future prevention and control strategies. Methods: Based on the reported data of typhus from 1950 to 2021 in China from the Infectious Disease History Database of China Public Health Science Data Center and the National Notifiable Infectious Disease Reporting Information System of Chinese Center for Disease Control and Prevention, we conducted a descriptive statistical analysis. Mann-Kendall test and circular distribution method were used to analyze the incidence, mortality and case fatality of typhus to reveal the temporal, spatial and population distributions and diagnosis of typhus in China. Results: From 1950 to 2021, a total of 452 965 typhus cases and 7 339 typhus deaths were reported in China, with the cases numbers exceeding 10 000 in 14 years of the 1950s, 1960s and 1980s, respectively. Since 1990s, the reported cases and incidence rate of typhus have decreased dramatically and the most cases were sporadic. However, the reported typhus cases in Anhui, Hubei, Hunan Provinces showed significant uptrends. Although typhus could occur all the year round, but the seasonality was observed with the incidence mainly in summer and autumn. For different provinces from the north to the south, the peaks of typhus' monthly incidence tended to shift to earlier dates. The male to female ratio of the cases was 1.01∶1 (18 529∶18 366). However, more cases occurred in women in recent years. The cases aged ≤9 years accounted for the highest proportion (18.9%), but the number of cases aged ≥50 years showed an upward trend. Most cases were farmers with the proportion increasing year by year. Moreover, the cases in students and scattered-living children also accounted for relatively higher proportions. The median of the interval between onset and diagnosis of typhus was 6 days. Most cases were clinically diagnosed, while the proportion of laboratory-confirmed cases was low and most laboratory cases were confirmed by Well-Felix reaction. Conclusions: Although the incidence and mortality of typhus in China has decreased significantly, the risk for local typhus outbreaks still exists. The prevention and control of typhus still face many challenges. It is indispensable to strengthen the pathogen detection and surveillance for typhus in China.

History, Rats, Fleas, and Opossums. II. The Decline and Resurgence of Flea-Borne Typhus in the United States, 1945-2019.

Flea-borne typhus, due to Rickettsia typhi and R. felis, is an infection causing fever, headache, rash, and diverse organ manifestations that can result in critical illness or death. This is the second part of a two-part series describing the rise, decline, and resurgence of flea-borne typhus (FBT) in the United States over the last century. These studies illustrate the influence of historical events, social conditions, technology, and public health interventions on the prevalence of a vector-borne disease. Flea-borne typhus was an emerging disease, primarily in the Southern USA and California, from 1910 to 1945. The primary reservoirs in this period were the rats Rattus norvegicus and Ra. rattus and the main vector was the Oriental rat flea (Xenopsylla cheopis). The period 1930 to 1945 saw a dramatic rise in the number of reported cases. This was due to conditions favorable to the proliferation of rodents and their fleas during the Depression and World War II years, including: dilapidated, overcrowded housing; poor environmental sanitation; and the difficulty of importing insecticides and rodenticides during wartime. About 42,000 cases were reported between 1931–1946, and the actual number of cases may have been three-fold higher. The number of annual cases of FBT peaked in 1944 at 5401 cases. American involvement in World War II, in the short term, further perpetuated the epidemic of FBT by the increased production of food crops in the American South and by promoting crowded and unsanitary conditions in the Southern cities. However, ultimately, World War II proved to be a powerful catalyst in the control of FBT by improving standards of living and providing the tools for typhus control, such as synthetic insecticides and novel rodenticides. A vigorous program for the control of FBT was conducted by the US Public Health Service from 1945 to 1952, using insecticides, rodenticides, and environmental sanitation and remediation. Government programs and relative economic prosperity in the South also resulted in slum clearance and improved housing, which reduced rodent harborage. By 1956, the number of cases of FBT in the United States had dropped dramatically to only 98. Federally funded projects for rat control continued until the mid-1980s. Effective antibiotics for FBT, such as the tetracyclines, came into clinical practice in the late 1940s. The first diagnostic test for FBT, the Weil-Felix test, was found to have inadequate sensitivity and specificity and was replaced by complement fixation in the 1940s and the indirect fluorescent antibody test in the 1980s. A second organism causing FBT, R. felis, was discovered in 1990. Flea-borne typhus persists in the United States, primarily in South and Central Texas, the Los Angeles area, and Hawaii. In the former two areas, the opossum (Didelphis virginiana) and cats have replaced rats as the primary reservoirs, with the cat flea (Ctenocephalides felis) now as the most important vector. In Hawaii, 73% of cases occur in Maui County because it has lower rainfall than other areas. Despite great successes against FBT in the post-World War II era, it has proved difficult to eliminate because it is now associated with our companion animals, stray pets, opossums, and the cat flea, an abundant and non-selective vector. In the new millennium, cases of FBT are increasing in Texas and California. In 2018–2019, Los Angeles County experienced a resurgence of FBT, with rats as the reservoir.

Physician to the fleet: the life and times of Thomas Trotter, 1760-1832.

Thomas Trotter, after studying medicine at Edinburgh, began his naval career as a surgeon's mate in 1779 and saw continuous service up to the peace of 1802, rising as a result of great abilities and the right patronage to become Physician to the Channel Fleet, and being present at the great battles of Dogger Bank in 1781 and the Glorious First of June in 1794. As Physician to the Channel Fleet, he was a major player in the conquest of scurvy and the control of typhus and smallpox in the navy. After the peace he settled in Newcastle where he produced pioneering work on alcoholism and neurosis, as a result of which he is regarded as one of the founders of the field of addiction studies. This book provides an intimate account of naval life in the great age of sail from the perspective of a surgeon, describing the impact of Enlightenment ideas and new medical techniques, and showing how improved health was a crucial factor in making possible the British fleet's great victories in this period. BRIAN VALE is a maritime historian, whose books include Independence or Death: British sailors and Brazilian Independence (Tauris 1996), A Frigate of King George, Life and Duty on a British Man-of-War (Tauris 2001) and The Audacious Admiral Cochrane (Conway 2004). GRIFFITH EDWARDS, Emeritus Professor at King's College, London, is one of the country's leading experts on addiction. His publications include Alchohol: the Ambiguous Molecule (Penguin 2000) and Matters of Substance (Penguin 2005).

Men of peace and the search for the perfect pesticide: conscientious objectors, the Rockefeller Foundation, and typhus control research.

Men of peace and the search for the perfect pesticide: conscientious objectors, the Rockefeller Foundation, and typhus control research.

Hospital Infection: From Miasmas to MRSA

Hospital Infection: From Miasmas to MRSA By Graham A. J. Ayliffe and Mary P. English (New York: Cambridge University Press, 2003) (288 pages; $100 cloth, $40 paper) For centuries, there has been much discussion about the problem of infections. In this book, Graham Ayliffe and Mary English, both distinguished scientists with extensive research backgrounds, provide a comprehensive, detailed account of the history of hospitalism, the word Sir James Simpson, professor of midwifery at Edinburgh in 1859, coined to describe hospital-acquired septic (p. 83). Beginning with the ancient belief that bad air (miasma) arising from decaying organic matter, cesspools, and marshes led to epidemic diseases, the authors highlight the commonly accepted theories of the spread of infection as well as the contributions of numerous physicians and scientists related to microbiology and the discovery of antibiotics. The authors also discuss in depth the major infectious diseases that have plagued nations throughout history and conclude with an account of the emergence of methicillin-resistant staphylococcus aureus (MRSA) in the 20th century. In the first three chapters, Ayliffe and English trace theories of infection from the Middle Ages through the 17th century, focusing on the universal acknowledgment of divine wrath and putrid air as the causes of disease. They highlight the Bubonic plague of the 14th century, and recount early attempts to control disease through fumigation, burning clothes and bedding, and quarantine. In the fourth chapter, the authors describe epidemics of typhus in military and civilian hospitals in the 18th and 19th centuries, discussing in detail how the pioneering work of British army surgeon John Pringle (1707-1782) was critical to the prevention of hospital infections in general and the control of typhus in particular (p. 41). In this chapter, Ayliffe and English address the contagion theory of disease, examining how contact between patients was responsible for such diseases as leprosy, smallpox and plague. Concentrating on the 19th century before Lister, the authors argue that the Norfolk and Norwich Hospitals were typical of many other hospitals in the 19th century, all of them affected severely by the rapid population increase and the consequent pressure on their wards and rise in the infection rate (p. 78). Paying particular attention to erysipelas, pyaemia, and hospital gangrene, Ayliffe and English examine the roles that overcrowding, defective ventilation, and inadequate nursing care played in the problem of hospital infections. In later chapters, the authors discuss theories of infection, highlighting the fact that it was Richard Mead, a leading London physician, who first suggested the idea that contagion was at least as important as aerial transmission in the spread of epidemics, and concluded that quarantine was most important in preventing the onslaught of plague in England. According to the authors, Mead's studies, first published in 1720, were a milestone in epidemiological thought ( p. 88). The book succeeds in many ways, one of which is the consistent recognition of lesser-known scientists and their achievements. …

How Charles Nicolle of the Pasteur Institute discovered that epidemic typhus is transmitted by lice: reminiscences from my years at the Pasteur Institute in Paris.

How Charles Nicolle of the Pasteur Institute discovered that epidemic typhus is transmitted by lice: reminiscences from my years at the Pasteur Institute in Paris.

The debate on DDT.

The paper reviews the early toxicologic and pharmacologic studies carried out by the author and his associates from 1943 to 1947, which were largely responsible for launching DDT as an agent for the control of typhus, malaria, yellow fever, and related vector-borne diseases. After reviewing recent studies conducted at the University of Miami, which dealt with organochlorine pesticides in human tissues, the tumorigenicity of aldrin, dieldrin and endrin (rat), six-generation mouse and three-generation dog reproduction studies, synergism of DDT and aldrin (dog), and the fate of DDT and aldrin during a period of severe starvation (rat), it is pointed out that it is primarily the overuse and misuse of DDT in pest control that have caused the pollution in our ecology. It is emphasized that the requirements for pest control differ the world over and that it must therefore be left to the national regulatory agencies to legislate the safe use of DDT and related pesticides. It is recommended that future human and animal studies with DDT and its derivatives give consideration to: (a) the balance and metabolism of the various hormones, (b) reproduction (estrus, libido, mammary development, milk production, (c) hepatic microsomal enzyme activities, (d) cancer prevention and cancer production, (e) excessive body weight changes induced by disease, unbalanced diet or starvation, and (f) the effects of DDT and its derivatives when absorbed in combination with other related and even unrelated compounds.

Concepts of louse-borne typhus control in developing countries: the use of the living attenuated E strain typhus vaccine in epidemic and endemic situations.

Louse-borne or epidemic typhus fever is without doubt one of the great epidemic diseases of mankind whose ebb and flow through the centuries has been important in the molding of human destiny (1). Much of our knowledge about typhus fever has come from experience in the unique setting of the temperate north of Europe (1–16) where its relative importance has declined as living conditions have improved over many years. Indeed, in recent times the epidemic potential of typhus in Europe has been realized primarily in the wake of the catastrophic disruptions caused by wars. Our attitude about relative importance, epidemiology, approaches to control and level of research support has been influenced strongly by the trends in modern, advanced Europe.

Status of the rickettsioses in the United States.

Excerpt INTRODUCTION The major medical problems connected with the rickettsioses affecting the human inhabitants of the United States have been solved. Nevertheless, rickettsial diseases continue t...

Typhus Control at Ports in Japan and Korea After World War II

Typhus Control at Ports in Japan and Korea After World War II

Evaluation of country-wide DDT dusting operations in murine typhus control 1946 through 1949.

Evaluation of County-Wide DDT Dusting Operations in Murine Typhus Control (1946 through 1949) Affiliation Elmer L. Hill, Harvey B. Morlan, Bernice C. Utterback, and Joseph H. Schubert CopyRight*Presented before the Laboratory Section of the American Public Health Association at the Seventy-eighth Annual Meeting in St. Louis, Mo., October 31, 1950.†From the Communicable Disease Center, Public Health Service, Federal Security Agency, Atlanta, Ga. This study from the Typhus Investigations Project at Thomasville, Ga., was made coöperatively with the Georgia Department of Public Health, C. D. Bowdoin, M.D., Director, Division of Preventable Diseases and Roy J. Boston, Director, Typhus Control Service. https://doi.org/10.2105/AJPH.41.4.396 Published Online: August 29, 2011

Typhus at Belsen. II. Clinical course of epidemic typhus in persons who had received Craigie typhus vaccine.

Article1 February 1951TYPHUS AT BELSEN. II. CLINICAL COURSE OF EPIDEMIC TYPHUS IN PERSONS WHO HAD RECEIVED CRAIGIE TYPHUS VACCINEWILLIAM A. DAVISWILLIAM A. DAVISSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-34-2-448 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptBritish troops who took part in the recent war in Europe were inoculated with Craigie typhus vaccine. During the typhus epidemic at Belsen in 1945, at least 14 of them contracted the disease. This provided an opportunity to observe naturally acquired epidemic typhus in persons who had received Craigie typhus vaccine. The primary purpose of this paper is to describe the clinical course of their illness with data on their previous inoculations and serologic responses.In the same epidemic, there were 16 cases of typhus among Hungarian soldiers who were inoculated with Craigie vaccine after exposure to the disease. There...Bibliography1. Zinsser H: Epidemiology and immunity in rickettsial disease, in Virus and rickettsial diseases, 1940, Harvard University Press, Cambridge, pp. 872-907. Google Scholar2. Cox HR: Use of yolk sac of developing chick embryo as medium for growing rickettsiae of Rocky Mountain spotted fever and typhus groups, Pub. Health Rep. 53: 2241-2247, 1938. CrossrefGoogle Scholar3. CoxBell HREJ: Epidemic and endemic typhus: protective value for guinea pigs of vaccines prepared from infected tissues of the developing chick embryo, Pub. Health Rep. 55: 110-115, 1940. CrossrefGoogle Scholar4. Craigie J: Application and control of ethyl ether water interface effects to the separation of rickettsiae from yolk sac suspensions, Canad. J. Research 23: Sect. E, 104-114, 1945. CrossrefGoogle Scholar5. ToppingShear NHMJ: Section III. Studies of antigens in infected yolk sac, U. S. National Institute of Health Bulletin No. 183, 13-16, Washington, D. C., 1945. Google Scholar6. EckeGilliamSnyderYeomansZarafonetis RSAGJCACJ: The effect of Cox-type vaccine on louse-borne typhus fever, Am. J. Trop. Med. 25: 447-462, 1945. CrossrefMedlineGoogle Scholar7. Sadusk JF: Typhus fever in the United States Army following immunization, J. A. M. A. 133: 1192-1199, 1947. CrossrefMedlineGoogle Scholar8. Topping NH: Notes on the preparation of epidemic typhus vaccine, N. I. H. Bulletin No. 183, 30-32, Washington, D. C., 1945. Google Scholar9. CraigieWatsonClarkMalcomson JDWEMME: The serological relationships of the rickettsiae of epidemic and murine typhus, Canad. J. Research 24: Sect. E., 84-103, 1946. CrossrefMedlineGoogle Scholar10. Davis WA: Typhus at Belsen. I. Control of the epidemic, Am. J. Hyg. 46: 66-83, 1947. MedlineGoogle Scholar11. Murchison C: A treatise on the continued fevers of Great Britain, 3rd Edition, 1884, London. Google Scholar12. WolbachToddPalfrey SBJLFW: The etiology and pathology of typhus, 1922, Harvard University Press, Cambridge, Mass. Google Scholar13. SoperDavisMarkhamRiehl FLWAFSLA: Typhus fever in Italy, 1943-1945, and its control with louse powder, Am. J. Hyg. 45: 305-334, 1947. CrossrefGoogle Scholar14. Van den EndeStuart-HarrisFultonNivenAndrewesBeggElfordGleeson-WhiteHawleyMillsHamiltonThomas MCHFJSCHAMWSMHWLKCFCC: Chemotherapeutic and other studies of typhus, Medical Research Council, Special Report Series No. 255, London, H. M. Stationery Office, 1946. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Glen Ridge, N. J.*Received for publication January 27, 1949.From the United States of America Typhus Commission, War Department, Washington 25, D. C.†Formerly Major, M. C., A. U. S.; Consultant on typhus from the United States of America Typhus Commission to the 21st Army Group.It is a pleasure to acknowledge the unfailing coöperation of Lt. Col. M. W. Gonin, D. S. O., R. A. M. C., who collaborated in these studies. I am also indebted to Major C. J. Zarafonetis, M. C., A. U. S., who was responsible for the serologic examinations, to Dr. Ruth Pitt-Rivers, who made the determinations of NPN, and to many at Belsen who helped in the care of typhus patients under epidemic conditions. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByConcepts of Louse-Borne Typhus Control in Developing Countries: The Use of the Living Attenuated E Strain Typhus Vaccine in Epidemic and Endemic SituationsVIRAL VACCINES AND HUMAN WELFARE 1 February 1951Volume 34, Issue 2Page: 448-465KeywordsInoculationPatientsTyphusVaccines Issue Published: 1 February 1951 PDF DownloadLoading ...

Evaluation of County-Wide DDT Dusting Operations in Murine Typhus Control, 1950

Evaluation of County-Wide DDT Dusting Operations in Murine Typhus Control, 1950

Gonzalo Piédrola Gil Recientes Adquisiciones y Tecnicas de Empleo del D. D. T.

This Spanish monograph of 320 pages reviews the literature relating to DDT, including some publications of 1947. In successive chapters are discussed the general properties of natural and synthetic insecticides; pathology and symptoms exhibited by insects poisoned by DDT; the determination of DDT; techniques for employment; general indications for the employment of DDT and its utility in human epidemiology; applications in agriculture, animal husbandry and certain industries. The volume closes with a biographical sketch of Dr. Paul Muller, and paraphrases American and English accounts of the control of typhus in Naples. While the compilation may be expected to be of considerable current service, the vast and expanding literature relating to this useful and important substance soon renders any review obsolete unless revised at frequent intervals.

Evaluation of County-Wide DDT Dusting Operations in Murine Typhus Control

Evaluation of County-Wide DDT Dusting Operations in Murine Typhus Control

Control of Typhus in Italy 1943-1944 by Use of DDT

Control of Typhus in Italy 1943-1944 by Use of DDT Affiliation Charles M. Wheeler CopyRight*Based on a paper presented before the Epldemiology Section of the American Public Health Association at the Seventy-third Annual Meeting in New York, N. Y., October 3, 1944. https://doi.org/10.2105/AJPH.36.2.119 Published Online: August 29, 2011

Typhus Control Praised

Typhus Control Praised

Typhus in Palestine

ACCORDING to the Lancet of October 16, there have been 23 deaths from an outbreak of typhus during the past eight months in Palestine. The southern districts were chiefly affected, and the Department of Health has prepared special delousing units and portable showers for use in future cases. The disease is thought to have been introduced from neighbouring countries, especially Egypt. Murine typhus conveyed by rats is endemic in Palestine, but the present epidemic, which is more serious, is lice-borne and has not been seen in Palestine since the end of the War of 1914-18. A vaccine has been used with good effect, and a special laboratory for research and control of typhus has been opened under the charge of Prof. Kligler, head of the Department of Bacteriology and Hygiene(see also NATUBE of November 27, p. 627).

Advances in Methods of Murine Typhus Control

Advances in Methods of Murine Typhus Control Roy J. Boston CopyRight*Read before the Engineering Section of the American Public Health Association at the Sixty-ninth Annual Meeting in Detroit, Mich., October 10, 1940. https://doi.org/10.2105/AJPH.31.7.720 Published Online: August 29, 2011