International travel and health

Typhus fever (Epidemic louse-borne typhus)

Cause

Rickettsia prowazekii.

Transmission

The disease is transmitted by the human body louse, which becomes infected by feeding on the blood of patients with acute typhus fever. Infected lice excrete rickettsia onto the skin while feeding on a second host, who becomes infected by rubbing louse faecal matter or crushed lice into the bite wound. There is no animal reservoir.

Nature of the disease

The onset is variable but often sudden, with headache, chills, high fever, prostration, coughing and severe muscular pain. After 5–6 days, a macular skin eruption (dark spots) develops first on the upper trunk and spreads to the rest of the body but usually not to the face, palms of the hands or soles of the feet. The case–fatality rate is up to 40% in the absence of specific treatment. Louse-borne typhus fever is the only rickettsial disease that can cause explosive epidemics.

Geographical distribution

Typhus fever occurs in colder (i.e. mountainous) regions of central and eastern Africa, central and South America, and Asia. In recent years, most outbreaks have taken place in Burundi, Ethiopia and Rwanda. Typhus fever occurs in conditions of overcrowding and poor hygiene, such as in prisons and refugee camps.

Risk for travellers

Very low for most travellers. Humanitarian relief workers may be exposed in refugee camps and other settings characterized by crowding and poor hygiene.

Prophylaxis

None.

Precautions

Cleanliness is important in preventing infestation by body lice. Insecticidal powders are available for body-louse control and treatment of clothing for those at high risk of exposure.

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