Typhus epidemiology and demographics
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
The Centers for Disease Control and Prevention have documented only 47 cases from 1976 to 2010. According to the World Health Organization, the case fatality rate from typhus is about 1 out of every 5,000,000 people per year. All age groups are at risk for rickettsial infections during travel to endemic areas. The typhus group of infections has no sexual predilection. Scrub typhus, which is transmitted by mites encountered in high grass and brush, is endemic in northern Japan, Southeast Asia, the western Pacific Islands, eastern Australia, China, maritime areas and several parts of south-central Russia, India, and Sri Lanka. R. typhi and R. felis, which are transmitted by fleas, are widely distributed, especially throughout the tropics and subtropics and in port cities and coastal regions with rodents.[1][2]
Epidemiology and Demographics
Incidence
- The Centers for Disease Control and Prevention have documented only 47 cases from 1976 to 2010.
Case fatality rate
- According to the World Health Organization, the case fatality rate from typhus is about 1 out of every 5,000,000 people per year.
Age
- All age groups are at risk for rickettsial infections during travel to endemic areas.
Gender
- The typhus group of infections has no sexual predilection.
Geographic distribution
- Scrub typhus, which is transmitted by mites encountered in high grass and brush, is endemic in northern Japan, Southeast Asia, the western Pacific Islands, eastern Australia, China, maritime areas and several parts of south-central Russia, India, and Sri Lanka.
- Most travel-acquired cases of scrub typhus occur during visits to rural areas in endemic countries for activities such as camping, hiking, or rafting, but urban cases have also been described.
- R. typhi and R. felis, which are transmitted by fleas, are widely distributed, especially throughout the tropics and subtropics and in port cities and coastal regions with rodents.
- Humans exposed to flea-infested cats, dogs, and peridomestic animals while traveling in endemic regions, or who enter or sleep in areas infested with rodents, are at most risk for fleaborne rickettsioses.
- Murine typhus has been reported among travelers returning from Asia, Africa, and the Mediterranean Basin and has also been reported from Hawaii, California, and Texas in the United States.
- Epidemic typhus is rarely reported among tourists but can occur in communities and refugee populations where body lice are prevalent.
- Travelers at most risk for epidemic typhus include those who may work with or visit areas with large homeless populations, impoverished areas, refugee camps, and regions that have recently experienced war or natural disasters.
- Active foci of epidemic typhus are known in the Andes regions of South America and some parts of Africa (including but not limited to Burundi, Ethiopia, and Rwanda).
- Louseborne epidemic typhus does not regularly occur in the United States, but a zoonotic reservoir occurs in the southern flying squirrel, and sporadic sylvatic epidemic typhus cases are reported.
- Tick-associated reservoirs of R. prowazekii have been described in Ethiopia, Mexico, and Brazil, but documented human cases are rare.