TY - JOUR
T1 - History, rats, fleas, and opossums. Ii. the decline and resurgence of flea-borne typhus in the united states, 1945–2019
AU - Anstead, Gregory M.
N1 - Funding Information:
Funding: This research was funded by the Department of Veterans Affairs and the Foundation for Advancing Veterans’ Health Research. Advancing Veterans’ Health Research. Acknowledgments: I thank Susan Bolden of the University of Texas Health-San Antonio Multimedia and Web Services for assistance with the figures. I also thank Bonny Mayes from the Texas Informed Consent Statement: Not applicable. Department of State Health Services and Uyen Truong from the Hawaii State Department of HAecaklntho wfolre pdrgomveidnitnsg: IththeaFnBkTS udsaatna fBoorl dtheeniro sfttahteesU. nIiavmersgirtaytoeffuTle txoa sBHreenadltah L-SinanckAe-nFtoisnsieoleMr oufl ttihmee dia and Web Services for assistance with the figures. I also thank Bonny Mayes from the Texas Department of State Health Services and Uyen Truong from the Hawaii State Department of Health for providing the FBT data for their states. I am grateful to Brenda Lincke-Fisseler of the Friench Simpson Memorial Library in Hallettsville, TX for providing articles about the typhus immunization program there.
Funding Information:
After serving two years with the USPHS on FBT control in San Antonio, David Davis joined the faculty of Johns Hopkins University School of Hygiene and Public Health. Along with biologists John Emlen Jr and John Calhoun, Davis formed the Rodent Ecology Project, which was funded by the Rockefeller Foundation. From 1946–1952, this group studied the ecology, behavior, population dynamics, health, predation, and control of urban rats [66–68]. By the early 1950s, there were increasing efforts in American cities to use a multi-modal approach to rodent control with sanitation, elimination of harborage, and rodent-resistant construction as the most important measures; trapping and rodenticide application were secondary methods [44]. There was also increasing integration of the rodent control activities of the public health sector (inspection and enforcement of building, sanitation, and health codes) with environmental remediation and rodenticide application by commercial exterminators [69].
Publisher Copyright:
© 2020 by the author. Licensee MDPI, Basel, Switzerland.
PY - 2021
Y1 - 2021
N2 - 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 mid1980s. 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.
AB - 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 mid1980s. 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.
KW - Flea
KW - Insecticide
KW - Opossums
KW - Rats
KW - Rickettsa typhi
KW - Rickettsia felis
KW - Rodenticide
UR - http://www.scopus.com/inward/record.url?scp=85106954788&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85106954788&partnerID=8YFLogxK
U2 - 10.3390/tropicalmed6010002
DO - 10.3390/tropicalmed6010002
M3 - Review article
C2 - 33379251
AN - SCOPUS:85106954788
SN - 2414-6366
VL - 6
JO - Tropical Medicine and Infectious Disease
JF - Tropical Medicine and Infectious Disease
IS - 1
M1 - 2
ER -