Published Date: 2005-01-28 23:50:00
Subject: PRO/EDR> Typhus - Ukraine (Vinnitsa): RFI
Archive Number: 20050128.0313
TYPHUS - UKRAINE (VINNITSA): REQUEST FOR INFORMATION
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Fri, 28 Jan 2005
Source: Tass.ru [edited]
52 schoolchildren are sick with typhus in the Ukrainian city of Vinnitsa,
according to deputy chief sanitary doctor of the city Larisa Bezdukhova.
She told a press conference on Thu, 27 Jan 2005, doctors were stunned to
learn about the outbreak of the infectious disease, which is typical of
wartime, when people often get lice-ridden when living in big groups in
cold, misery, hunger, and without elementary conveniences.
Bezdukhova said the situation will be examined by regional sanitary
[ProMED would like more information regarding this cluster of illness. It
is commonplace in this area of the globe for typhoid fever to be referred
to as abdominal typhus, and this moderator wonders whether there is some
misunderstanding about the nature of the children's illnesses.
Be that as it may, epidemic typhus is a vector-borne disease with a complex
epidemiology. Lice -- the vectors -- live in clothing; therefore weather,
humidity, and hygiene determine their prevalence. Consequently, the body or
clothing louse is more prevalent during the colder months, and epidemic
typhus is more frequently reported during the winter and early spring.
The permanent foci of the body louse exist in regions subject to cold
weather, where inhabitants need to wear multiple layers of clothes, and in
poverty-stricken communities whose inhabitants lack multiple sets of
clothes. Such populations are most common in mountainous regions of
countries in intertropical zones, including Ethiopia, Burundi, and Rwanda
in Africa, Peru in South America, and Nepal and Tibet in central Asia. The
prevalence of body lice increases with altitude. Infestation with lice is
more frequent during wars, in trenches and in jail, where conditions are
cramped, when it is cold, and where hygiene is limited. Large outbreaks of
lice have been associated with the recent civil wars in Burundi. An
outbreak of typhus occurred in jail in Burundi, and subsequently, a huge
outbreak of typhus occurred in several refugee camps where nearly all
inhabitants were louse-infested.
The body louse attaches its eggs to clothing, not to the body or hair,
often on the inner belts of underwear, pants or skirts. When removed from
the body, even in the absence of insecticides, the unwashed clothes will be
absent of viable lice and eggs within 7 days. Raoult and Roux (1) cite
Maunder (2), who hypothesized that religious Sabbath and Sunday ritual days
of rest with a change of clothes could be attributed to a delousing cycle.
In this setting, therefore, unless the children were not changing their
clothes regularly or they were exposed to an aerosol of infective louse
feces, not necessarily as a criminal act, it would be unusual for the
illness to be epidemic typhus fever. _Rickettsia prowazekii_, however, is
considered a category B biowarfare agent because of the propensity for
infective louse feces to be aerosolized.
1. Raoult D, Roux, V: The body louse as a vector of reemerging human
diseases. Clin Infect Dis 1999;29:888-911.
2. Maunder JW: The appreciation of lice. Proc Roy Inst Great Britain.