Typhus and its control in Russia, 1870-1940.

Typhus was a major health problem in late nineteenthand early twentieth-century Russia. Closely linked with poverty and overcrowded housing, this louse-borne disease was endemic in both rural and urban areas, with scattered cases and small outbreaks occurring every year, mostly in the winter and early spring. Great epidemics flared up whenever war or famine produced hardship and massive population movements. The worst typhus epidemics took place late in World War I and in the years of civil war following the Bolshevik Revolution. Typhus claimed some 2 to 3 million lives from 1918 to 1922. Incidence rates fell dramatically in the later 1920s and the disease had ceased to be a significant cause of death by 1940. There was, however, a sharp flare-up in the early 1930s, undoubtedly associated with the dislocations caused by Stalin's industrialization and collectivization drives, and the ensuing famines. Typhus is an acute febrile disease caused by a rickettsial organism, Rickettsia prowazeki. The pathogen is transmitted by the body louse Pediculus humanus. As the insect lives in the clothes of its host, the Russian term platyanaya vosh', clothes louse, is more accurate than the English term. Lice attach to their host for blood meals and acquire rickettsias from typhus patients. They transmit infection to other hosts if their pathogen-rich faeces are inoculated through abrasions in the skin, as, for example, when a louse bite is scratched. Symptoms include high fever, prostration, mental confusion, and a characteristic rash. People of all ages are susceptible to typhus, although children tend to have milder cases. Differential exposure to infected lice often produces higher attack rates in males of military or working age than in females, children, or the elderly. Case mortality rates range from 5 to 40 per cent and even higher. The role of lice as vectors was proved in 1909 by Charles Nicolle. The pathogen was discovered in 1916, but questions about its role were not finally resolved for several more years.'