History, Rats, Fleas, and Opossums. II. The Decline and Resurgence of Flea-Borne Typhus in the United States, 1945–2019

Abstract

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 mid-1980s. 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.

Assessing transmission patterns of flood-related waterborne diseases in two urban municipalities of Côte d’Ivoire

“…In Kuala Lumpur (Malaysia), authors showed the association between rodent distribution and disease transmission, and the change in climate conditions (Mackenzie & Williams, 2009; Naing, Reid, Aye, Htet, & Ambu, 2019). This correlation was also highlighted in a study conducted in the United States of America about rodent borne disease occurrences (Anstead, 2021). Other studies reported on the effect of meteorological conditions on rodent population dynamics and transmission by Rattus rattus sp.…”

Overcrowding and Hazardous Dwelling Condition Characteristics: A Systematic Search and Scoping Review of Relevance for Health

“…Finally, 12 records were excluded as the content selected for in the title and abstract did not correspond to the content in the full text. Thus, our record identification, screening, and assessment resulted in the inclusion of 100 records [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 ,…”

“…Some of the 94 category B papers described dwelling condition characteristics not previously mentioned, e.g., fomites and surfaces contaminated with infectious agents, and pests serving as vectors [ 9 , 62 ] for pathogenic bacteria, viruses, and amoebas. Characteristics sometimes coincide or are combined; for example, Huet et al [ 50 ] used the following survey question to define need of repair: ‘‘Does your home have a problem with mold or is in need of major repairs (for example: a new roof, plumbing repairs, structural repairs)?’’ .…”

“…Our eighth and final key observation in relation to overcrowding is that pesticides/biocides are, reasonably, a major public health concern and have been for a long time. Several of the records we reviewed cover biocides used indoors against mold and vermin, e.g., [ 9 , 21 , 27 , 28 , 33 , 36 , 60 , 81 , 87 , 101 ]. The experts behind the WHO report on dampness and mold speculated that “the levels of semi-volatile compounds, such as pentachlorophenol (a wood preservative) and other pesticides, may also be elevated in damp indoor environments”.…”

Metagenomics of culture isolates and insect tissue illuminate the evolution ofWolbachia,RickettsiaandBartonellasymbionts inCtenocephalidesspp. fleas

“…), have been considered as poor plague vectors [2]. A second zoonotic disease transmitted predominantly by X. cheopis is murine typhus, caused by Rickettsia typhi (Rickettsiales), which is mainly associated with urban or peri-urban environments in the tropics and subtropics [3]. The genus Ctenocephalides originated in Africa but now includes two cosmopolitan species, the cat flea Ctenocephalides felis and the dog flea Ctenocephalides canis, although C. felis is more prevalent on dogs worldwide than C. canis.…”