Editing Epidemic typhus (section)

==History==

=== History of outbreaks ===

==== Before 19th century ====
During the second year of the [[Peloponnesian War]] (430 BC), the [[city-state]] of [[History of Athens|Athens]] in ancient [[Greece]] had an epidemic, known as the [[Plague of Athens]], which killed, among others, [[Pericles]] and his two elder sons. The plague returned twice more, in 429 BC and in the winter of 427/6 BC. Epidemic typhus is proposed as a strong candidate for the cause of this disease outbreak, supported by both medical and scholarly opinions.<ref>At a January 1999 medical conference at the [[University of Maryland, College Park|University of Maryland]], Dr. David Durack, consulting professor of medicine at [[Duke University]] notes: "Epidemic typhus fever is the best explanation. It hits hardest in times of war and privation, it has about 20 percent mortality, it kills the victim after about seven days, and it sometimes causes a striking complication: gangrene of the tips of the fingers and toes. The Plague of Athens had all these features." see also: [http://www.umm.edu/news/releases/athens.html umm.edu] {{Webarchive|url=https://web.archive.org/web/20200408153546/http://www.umm.edu/news/releases/athens.html |date=2020-04-08 }}</ref><ref>{{cite book |author-link=Arnold Wycombe Gomme |last=Gomme |first=A.W. |editor-first=A. |editor-last=Andrewes |editor2-first=K.J. |editor2-last=Dover |chapter=Volume 5. Book VIII |title=An Historical Commentary on Thucydides |publisher=Oxford University Press |year=1981 |isbn=978-0-19-814198-3 }}</ref>

[[File:Epidemic typhus Burundi.jpg|thumb|Rash caused by epidemic typhus in Burundi]]
The first description of typhus was probably given in 1083 at [[La Trinità della Cava|La Cava abbey]] near [[Salerno]], [[Italy]].<ref>{{cite web |first=Waclaw |last=Szybalski |title=Maintenance of human-fed live lice in the laboratory and production of Weigl's exanthematous typhus vaccine |year=1999 |url=http://www.lwow.home.pl/Weigl.html |access-date=2005-05-21 |archive-date=2021-09-04 |archive-url=https://web.archive.org/web/20210904102439/https://www.lwow.home.pl/Weigl.html |url-status=live }}</ref><ref>{{cite book |first=Beppe |last=Carugo |title=Breve Storia della Medicina, della Diagnostica, delle Arti Sanitarie |year=2006 |edition=2nd |url=http://www.qualitologia.it/attivita/27.pdf |access-date=2013-10-02 |archive-date=2013-10-05 |archive-url=https://web.archive.org/web/20131005002314/http://www.qualitologia.it/attivita/27.pdf |url-status=dead }}</ref> In 1546, [[Girolamo Fracastoro]], a [[Florence|Florentine]] physician, described typhus in his famous treatise on viruses and contagion, ''De Contagione et Contagiosis Morbis''.<ref>{{cite book |last=Fracastoro |first=Girolamo |author-link=Girolamo Fracastoro |title=De Contagione et Contagiosis Morbis |url=https://archive.org/details/bub_gb_B580FxRJwQUC |year=1546 |publisher=apud heredes Lucantonii Iuntae }}</ref>

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.{{citation needed|date=May 2021}}

Typhus was also common in prisons (and in crowded conditions where lice spread easily), where it was known as ''Gaol fever'' or ''Jail fever''.<ref name="Smith 2019 c252">{{cite web | last=Smith | first=Kiona N. | title=What's The Difference Between Typhus And Typhoid? | website=Forbes | date=January 30, 2019 | url=https://www.forbes.com/sites/kionasmith/2019/01/30/whats-the-difference-between-typhus-and-typhoid/?sh=4b7caab4342a | access-date=February 24, 2024 | archive-date=February 24, 2024 | archive-url=https://web.archive.org/web/20240224163810/https://www.forbes.com/sites/kionasmith/2019/01/30/whats-the-difference-between-typhus-and-typhoid/?sh=4b7caab4342a | url-status=live }}</ref> 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 (Speaker)|Robert Bell]], [[Lord Chief Baron of the Exchequer]].<ref name="Webb_1857">{{cite journal |last1=Webb |first1=Francis C. |date=October 1857 |title=Historical Account of Gaol Fever |journal=The Sanitary Review and Journal of Public Health |volume=3 |issue=11 |pages=T64 |pmid=30378948 |pmc=5981523 }}</ref> The outbreak that followed, between 1577 and 1579, killed about 10% of the [[English people|English population]]. {{citation needed|date=May 2021}}

During the [[assizes|Lent assize]] 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.<ref>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</ref> In [[London]], typhus frequently broke out among the ill-kept prisoners of [[Newgate Gaol]] and moved into the general city population.{{citation needed|date=September 2022}}

==== 19th century ====
Epidemics occurred in the British Isles and throughout Europe, for instance, during the [[English Civil War]], the [[Thirty Years' War]], and the [[Napoleonic Wars]]. Many historians believe that the typhus outbreak among Napoleon's troops is the real reason why he stalled his military campaign into Russia, rather than starvation or the cold.<ref name=":3">{{Cite web|title=Typhus- Biological Weapons|url=https://www.globalsecurity.org/wmd/intro/bio-typhus.htm|access-date=2020-10-09|website=www.globalsecurity.org|archive-date=2020-10-16|archive-url=https://web.archive.org/web/20201016132141/https://www.globalsecurity.org/wmd/intro/bio-typhus.htm|url-status=live}}</ref> A major epidemic occurred in [[Ireland]] between 1816 and 1819, and again in the late 1830s. Another major typhus epidemic occurred during the [[Great Famine (Ireland)|Great Irish Famine]] between 1846 and 1849. The Irish typhus spread to England, where it was sometimes called "Irish fever" and was noted for its virulence. It killed people of all social classes since lice were endemic and inescapable, but it hit particularly hard in the lower or "unwashed" social strata. It was carried to North America by the many Irish refugees who fled the famine. In Canada, the [[1847 North American typhus epidemic]] killed more than 20,000 people, mainly Irish immigrants in [[fever shed]]s and other forms of quarantine, who had contracted the disease aboard [[coffin ships]].<ref name=mccord1>{{cite web|id=M993X.5.1529.1|title=The government inspector's office|url=http://www.mccord-museum.qc.ca/en/collection/artifacts/M993X.5.1529.1|work=[[McCord Museum]]|access-date=22 January 2012|location=[[Montreal]]|archive-date=8 April 2011|archive-url=https://web.archive.org/web/20110408035406/http://www.mccord-museum.qc.ca/en/collection/artifacts/M993X.5.1529.1|url-status=live}}</ref> As many as 900,000 deaths have been attributed to the typhus fever during the Crimean War in 1853–1856,<ref name=":3" /> and 270,000 to the [[1866 Finnish typhus epidemic]].<ref>Ulla Piela, 'Loitsut 1800-luvun Pohjois-Karjalassa', ''Kalevalaseuran vuosikirja'', 68 (1989), 82–107 (p. 82).</ref>

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, Tennessee|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.<ref>{{Cite journal |last=Sartin |first=Jeffrey S. |date=1993-04-01 |title=Infectious Diseases During the Civil War: The Triumph of the “Third Army” |url=https://academic.oup.com/cid/article-abstract/16/4/580/413040?redirectedFrom=fulltext |journal=Clinical Infectious Diseases |volume=16 |issue=4 |pages=580–584 |doi=10.1093/clind/16.4.580 |issn=1058-4838}}</ref>

[[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.{{citation needed|date=May 2021}}

==== 20th century ====
Typhus was [[Endemic typhus|endemic]] in [[Poland]] and several neighboring countries prior to [[World War I]] (1914–1918).<ref>{{Cite web|title=Health, Disease, Mortality; Demographic Effects {{!}} International Encyclopedia of the First World War (WW1)|url=https://encyclopedia.1914-1918-online.net/article/health_disease_mortality_demographic_effects|access-date=2021-02-26|website=encyclopedia.1914-1918-online.net|archive-date=2020-11-18|archive-url=https://web.archive.org/web/20201118080257/https://encyclopedia.1914-1918-online.net/article/health_disease_mortality_demographic_effects|url-status=live}}</ref><ref>{{Cite journal|last=Goodall|first=E. W.|date=April 23, 1920|title=Typhus Fever in Poland, 1916 to 1919.|journal=Section of Epidemiology and State Medicine|volume=13|issue=Sect Epidemiol State Med|pages=261–276|doi=10.1177/003591572001301507|pmid=19981289|pmc=2152684}}</ref> During and shortly after the war, epidemic typhus caused up to three million deaths in [[Russian Empire|Russia]], and several million citizens also died in Poland and [[Romania]].<ref name=":6" /><ref>{{Cite web|title=Typhus, War, and Vaccines|url=https://www.historyofvaccines.org/content/blog/typhus-war-and-vaccines|access-date=2021-02-26|website=History of Vaccines|language=en|archive-date=2021-02-28|archive-url=https://web.archive.org/web/20210228050952/https://www.historyofvaccines.org/content/blog/typhus-war-and-vaccines|url-status=dead}}</ref> Since 1914, many troops, prisoners and even doctors were infected, and at least 150,000 died from typhus in [[Serbia]], 50,000 of whom were prisoners.<ref>{{Cite journal|last=Pennington|first=Hugh|date=2019-01-10|title=The impact of infectious disease in war time: a look back at WW1|journal=Future Microbiology|volume=14|issue=3|pages=165–168|doi=10.2217/fmb-2018-0323|pmid=30628481|issn=1746-0913|doi-access=free}}</ref><ref>{{Cite web|last=|first=|title=Typhus in World War I|url=https://microbiologysociety.org/publication/past-issues/world-war-i/article/typhus-in-world-war-i.html|access-date=2021-02-26|website=Microbiology Society|archive-date=2021-03-08|archive-url=https://web.archive.org/web/20210308213901/https://microbiologysociety.org/publication/past-issues/world-war-i/article/typhus-in-world-war-i.html|url-status=live}}</ref><ref>{{Cite journal|last=Soubbotitch |first=V.|date=November 30, 1917|title=A Pandemic of Typhus in Serbia in 1914 and 1915|journal=Section of Epidemiology and State Medicine|volume=11|pages=31–39|doi=10.1177/003591571801101302|s2cid=42043208|doi-access=free}}</ref> Delousing stations were established for troops on the [[Western Front (World War I)|Western Front]], but the disease ravaged the armies of the [[Eastern Front (World War I)|Eastern Front]]. Fatalities were generally between 10 and 40 percent of those infected, and the disease was a major cause of death for those nursing the sick. During World War I and the [[Russian Civil War]] between the [[White Army|White]] and [[Red Army|Red]], the typhus epidemic caused 2–3 million deaths out of 20–30 million cases in Russia between 1918 and 1922.<ref name=":6">{{cite journal|author=Patterson KD|year=1993|title=Typhus and its control in Russia, 1870–1940|journal=Med Hist|volume=37|issue=4|pages=361–381 [378]|doi=10.1017/s0025727300058725|pmc=1036775|pmid=8246643}}</ref>
[[Image:DDT WWII soldier.jpg|thumb|upright|left|A U.S. soldier demonstrating [[DDT]]-hand spraying equipment. DDT was used to control the spread of typhus-carrying [[lice]] during WWII.]]
Typhus caused hundreds of thousands of deaths during [[World War II]].<ref name="Zinsser">{{cite book|last=Zinsser|first=Hans|url=https://archive.org/details/ratslicehistoryb00zins_0|title=Rats, Lice and History: A Chronicle of Pestilence and Plagues|publisher=Black Dog & Leventhal|year=1996|isbn=978-1-884822-47-6|location=New York|author-link=Hans Zinsser|orig-year=1935|url-access=registration}}</ref> It struck the [[German Army (Wehrmacht)|German Army]] during [[Operation Barbarossa]], the invasion of Russia, in 1941.<ref name="Mazal1" /> In 1942 and 1943 typhus hit [[French North Africa]], [[Egypt]] and [[Iran]] particularly hard.<ref name="history.amedd.army.mil"/> Typhus epidemics killed inmates in the [[Nazi concentration camps]] and death camps such as [[Auschwitz]], [[Dachau]], [[Theresienstadt]], and [[Bergen-Belsen concentration camp|Bergen-Belsen]].<ref name="Mazal1" /> Footage shot at [[Bergen-Belsen concentration camp]] shows the mass graves for typhus victims.<ref name="Mazal1" /> [[Anne Frank]], at age 15, and her sister Margot both died of typhus in the camps. Even larger epidemics in the post-war chaos of Europe were averted only by the widespread use of the newly discovered [[DDT]] to kill lice on the millions of refugees and [[displaced persons]].{{citation needed|date=December 2020}}

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.{{citation needed|date=December 2020}}

In one of its first major outbreaks since World War II, epidemic typhus reemerged in 1995 in a jail in [[Ngozi, Burundi|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.<ref>{{Cite journal|last1=Raoult|first1=D|last2=Ndihokubwayo|first2=JB|last3=Tissot-Dupont|first3=H|last4=Roux|first4=V|last5=Faugere|first5=B|last6=Abegbinni|first6=R|last7=Birtles|first7=RJ|date=1998-08-01|title=Outbreak of epidemic typhus associated with trench fever in Burundi|url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(97)12433-3/abstract|journal=The Lancet|language=en|volume=352|issue=9125|pages=353–358|doi=10.1016/S0140-6736(97)12433-3|pmid=9717922|s2cid=25814472|issn=0140-6736|archive-date=2021-12-11|access-date=2016-05-11|archive-url=https://web.archive.org/web/20211211082706/https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(97)12433-3/fulltext|url-status=live}}</ref>

==== 21st century ====
A 2005 study found seroprevalence of ''R. prowazekii'' antibodies in [[Homeless shelter|homeless populations in two shelters]] in [[Marseille, France]]. The study noted the "hallmarks of epidemic typhus and relapsing fever".<ref>{{Cite journal|last1=Brouqui|first1=Philippe|last2=Stein|first2=Andreas|last3=Dupont|first3=Hervé Tissot|last4=Gallian|first4=Pierre|last5=Badiaga|first5=Sekene|last6=Rolain|first6=Jean Marc|last7=Mege|first7=Jean Louis|last8=Scola|first8=Bernard La|last9=Berbis|first9=Philippe|title=Ectoparasitism and Vector-Borne Diseases in 930 Homeless People From Marseilles|journal=Medicine|volume=84|issue=1|pages=61–68|doi=10.1097/01.md.0000152373.07500.6e|pmid=15643300|year=2005|s2cid=24934110|doi-access=free}}</ref>

=== History of vaccines ===

Major developments for [[typhus]] [[vaccines]] started during [[World War I]], as typhus caused high mortality, and threatened the health and readiness for soldiers on the battlefield.<ref name=":2">{{Cite journal|last=Lindenmann|first=Jean|date=2002|title=Typhus Vaccine Developments from the First to the Second World War (On Paul Weindling's 'Between Bacteriology and Virology...')|journal=History and Philosophy of the Life Sciences|publisher=Stazione Zoologica Anton Dohrn – Napoli|volume=24|issue=3–4|pages=467–485|doi=10.1080/03919710210001714513|pmid=15045834|JSTOR=}}</ref> Vaccines for typhus, like other vaccines of the time, were classified as either living or killed vaccines.<ref name=":2"/> Live vaccines were typically an injection of live agent, and killed vaccines are live cultures of an agent that are chemically inactivated prior to use.<ref name=":2"/>

Attempts to create a living vaccine of classical, [[louse]]-borne, typhus were attempted by French researchers but these proved unsuccessful.<ref name=":2"/> Researchers turned to [[murine typhus]] to develop a live vaccine.<ref name=":2"/> 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.<ref name=":2"/>

While the French were making advancements with live vaccines, other European countries were working to develop killed vaccines.<ref name=":2"/> During [[World War II]], there were three kinds of potentially useful killed vaccines.<ref name=":2"/> All three killed vaccines relied on the cultivation of ''[[Rickettsia prowazekii]]'', the organism responsible for typhus.<ref name=":2"/> The first attempt at a killed vaccine was developed by [[Germany]], using the ''[[Rickettsia prowazekii]]'' found in louse feces.<ref name=":2"/> 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]].<ref name=":2"/>

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.<ref name=":2"/>

The last technique was an extended development of the previously known method of growing murine typhus in rodents.<ref name=":2"/> It was discovered that rabbits could be infected, by a similar process, and contract classical typhus instead of murine typhus.<ref name=":2"/> Again, while proven to produce suitable ''[[Rickettsia prowazekii]]'' for vaccine development, this method was not used to produce wartime vaccines.<ref name=":2"/>

During WWII, the two major vaccines available were the killed vaccine grown in lice and the live vaccine from [[France]].<ref name=":2"/> Neither was used much during the war.<ref name=":2"/> 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.<ref name=":2"/>

The Germans worked to develop their own live vaccine from the urine of typhus victims.<ref name=":2"/> While developing a live vaccine, Germany used live ''[[Rickettsia prowazekii]]'' to test multiple possible vaccines' capabilities.<ref name=":2"/> They gave live ''[[Rickettsia prowazekii]]'' to concentration camp prisoners, using them as a control group for the vaccine tests.<ref name=":2"/>

The use of [[DDT]] as an effective means of killing lice, the main carrier of typhus, was discovered in [[Naples]].<ref name=":2"/>