A Mixed Outbreak of Epidemic Typhus Fever and Trench Fever in a Youth Rehabilitation Center: Risk Factors for Illness from a Case-Control Study, Rwanda, 2012

Abstract

Abstract. In August 2012, laboratory tests confirmed a mixed outbreak of epidemic typhus fever and trench fever in a male youth rehabilitation center in western Rwanda. Seventy-six suspected cases and 118 controls were enrolled into an unmatched case-control study to identify risk factors for symptomatic illness during the outbreak. A suspected case was fever or history of fever, from April 2012, in a resident of the rehabilitation center. In total, 199 suspected cases from a population of 1,910 male youth (attack rate = 10.4%) with seven deaths (case fatality rate = 3.5%) were reported. After multivariate analysis, history of seeing lice in clothing (adjusted odds ratio [aOR] = 2.6, 95% confidence interval [CI] = 1.1-5.8), delayed (≥ 2 days) washing of clothing (aOR = 4.0, 95% CI = 1.6-9.6), and delayed (≥ 1 month) washing of beddings (aOR = 4.6, 95% CI = 2.0-11) were associated with illness, whereas having stayed in the rehabilitation camp for ≥ 6 months was protective (aOR = 0.20, 95% CI = 0.10-0.40). Stronger surveillance and improvements in hygiene could prevent future outbreaks.

Community acquired infections among refugees leading to Intensive Care Unit admissions in Turkey

“…Historical data suggested that migrant populations have higher rates of infectious syndromes leading to mortality like typhus, dysentery, relapsing fever, and typhoid fever. [7][8][9] The query at this point is whether the critical refugee patients were admitted to the ICUs with nonspecific infectious diseases like pneumonias or urinary infections as in non-migrant populations or were they taken to the ICUs with specific historical syndromes? 6 In order to explore the impact and nature of infections among refugees on ICUs in Turkey we did a retrospective cross-sectional multicenter study to analyze CA infections among refugee patients that required admission to the ICU.…”

La Valentine disease: An outbreak of exanthematic typhus in Marseille, France, in 1810

“…20 An outbreak was reported in Rwanda, in 2012, in the setting of a youth rehabilitation centre. 21 Body louse infestations among refugee and sheltering populations, living in overcrowded and unsanitary conditions because of the war in Ukraine, may trigger epidemics of R. prowazekii infection. 22 Finally, sylvatic typhus is another entity in the United States where the flying squirrel constitute a reservoir of R. prowazekii , and rare human cases have been described without implication of body lice.…”

Tick-, Flea-, and Louse-Borne Diseases of Public Health and Veterinary Significance in Nigeria

“…Reports of louse-borne typhus are not known in Nigeria since the 1940s, suggesting existing adequate public health measures are in place coupled with the near extinction of circulating body lice as in many other parts of the globe. However, louse-borne typhus remains on the WHO epidemic threat list for Africa and the continuing political instability and health crisis in many African countries may be a classic background for new outbreaks in conflict areas, as previously happened in Burundi in 1995–1997 [ 168 ] and Rwanda in 2012 [ 169 ]. One other rickettsial disease, scrub typhus, has recently received more attention in the context of the diagnosis of scrub-typhus-like cases outside of its classic endemic area [ 170 , 171 ], evidence for human exposure during passive surveillance [ 154 , 172 ], and molecular detection of Orientia DNA in these areas [ 173 , 174 ], so it may have been overlooked in Nigeria as well.…”