Public health, urban space and social exclusion in postwar Spain: the exanthematic typhus epidemic in the city of Valencia, 1941-1943. / Salud pública, espacio urbano y exclusión social en la España de posguerra: la epidemia de tifus exantemático en la ciudad de Valencia, 1941-1943.

After the Spanish Civil War, poor hygiene and nutritional deficiencies among a large part of Spain's population contributed to the rise of epidemic diseases. Exanthematic typhus posed a challenge to the health authorities, especially during the spring of 1941, when the epidemiological cycle of the disease and the lack of infrastructures combined to create a serious health crisis. The Franco regime, aware that this situation posed a threat to its legitimacy, promptly used social exclusion as part of its health policy against the epidemic. This article provides an in-depth analysis of the case of Valencia, a city that was behind Republican lines during the war, and therefore received successive waves of refugees as Franco's troops advanced.

Tras la Guerra Civil, las deficientes condiciones higiénico-dietéticas de gran parte de la población española favorecieron la aparición de enfermedades epidémicas. El tifus exantemático puso en jaque a las autoridades sanitarias, especialmente durante la primavera de 1941, cuando el ciclo epidemiológico de la enfermedad y la falta de infraestructuras se aliaron para provocar una grave crisis sanitaria. El régimen franquista, consciente de que esta situación dificultaba su legitimación, no dudó en utilizar la exclusión social como parte de su política sanitaria contra esta epidemia. El artículo analiza en profundidad el caso de Valencia, una ciudad que durante la guerra, por hallarse en la retaguardia republicana, había acogido sucesivas oleadas de refugiados a medida que avanzaban las tropas franquistas.

Salud pública, espacio urbano y exclusión social en la España de posguerra: la epidemia de tifus exantemático en la ciudad de Valencia, 1941-1943 / Public health, urban space and social exclusion in postwar Spain: the exanthematic typhus epidemic in the city of Valencia, 1941-1943

Resumen Tras la Guerra Civil, las deficientes condiciones higiénico-dietéticas de gran parte de la población española favorecieron la aparición de enfermedades epidémicas. El tifus exantemático puso en jaque a las autoridades sanitarias, especialmente durante la primavera de 1941, cuando el ciclo epidemiológico de la enfermedad y la falta de infraestructuras se aliaron para provocar una grave crisis sanitaria. El régimen franquista, consciente de que esta situación dificultaba su legitimación, no dudó en utilizar la exclusión social como parte de su política sanitaria contra esta epidemia. El artículo analiza en profundidad el caso de Valencia, una ciudad que durante la guerra, por hallarse en la retaguardia republicana, había acogido sucesivas oleadas de refugiados a medida que avanzaban las tropas franquistas.

Abstract After the Spanish Civil War, poor hygiene and nutritional deficiencies among a large part of Spain's population contributed to the rise of epidemic diseases. Exanthematic typhus posed a challenge to the health authorities, especially during the spring of 1941, when the epidemiological cycle of the disease and the lack of infrastructures combined to create a serious health crisis. The Franco regime, aware that this situation posed a threat to its legitimacy, promptly used social exclusion as part of its health policy against the epidemic. This article provides an in-depth analysis of the case of Valencia, a city that was behind Republican lines during the war, and therefore received successive waves of refugees as Franco's troops advanced.

[Red Cross war hospital in Rijeka (1914-1918)]. / Ratna bolnica Crvenog kriza u Rijeci (1914. ­ 1918.).

The article describes how the system of medical care for wounded soldiers in Rijeka during the First World War was organized. In the Austro-Hungarian Empire the hospital care for sick and wounded soldiers, except of a military health care, was under the exclusive jurisdiction of the Red Cross. The Municipal Committee of the Hungarian Red Cross in Rijeka, established in 1881, renewed its previously suspended activity in August 1914, with the task of starting a war hospital for wounded soldiers. For this purpose, the former Hotel for emigrants, a large modern building opened in 1908, was converted. It became the center of hospital care for wounded soldiers in the city. Also, under the supervision of the Red Cross in Rijeka several smaller auxiliary dispensaries were organized. The other city health care facilities and the most of the physicians in Rijeka were included in the care for the wounded. The head of the volunteer nurses of the Red Cross was the president of the Red Cross in Rijeka, Countess Sofia Wickenburg, the wife of the governor and at the same time the president of the Red Cross city branch. The medical staff in Rijeka was particularly noted for its successful and rapid suppression of a typhus epidemic in February and March 1915. The paper is based on research of archival funds in the State Archives in Rijeka and part of the Rijeka and Zagreb press.

[Typhus in Mexico City in 1915]. / El tifo en la Ciudad de Mexico en 1915.

The year 1915 was particularly difficult; it was characterized by droughts, famines, and outbreaks of diseases including typhus.This text exposes its spread in Mexico City as well as the measures implemented to combat it, carried out before knowing the etiology of the illness, focused on cleaning up the environment and the measures undertaken afterwards with the aim of delousing people.

The RAMC at Belsen 1945: typhus revisited.

OBJECTIVE: The Royal Army Medical Corps (RAMC) has justly regarded its relief of the appalling conditions found in the liberated Nazi concentration camp at Bergen-Belsen in April 1945 as one of its more glorious achievements. This view has, in the last decade, come under attack from historians who have, inter alia, criticised the nature and speed of the medical measures employed by the British. This has focused particularly on the management of the typhus epidemic, erroneously claimed to be the major disease killer of the survivors, and which was the catalyst for the premature German surrender of the camp to the approaching Allies about 3 weeks before the end of the war. This review examines the veracity of this statement and the nature of the evidence on which it was based. METHODS: Review of all the relevant extant primary source written evidence both published and archived in major collections in London, Washington and Belsen, in addition to the relevant subsequent secondary evidence. RESULTS: Disprove the ill-considered and scientifically flawed attempts to discredit the RAMC and demonstrate that the RAMC can be shown to have made the correct prioritising decisions in relieving starvation as well as in implementing the appropriate public health anti-typhus measures and to have acquitted itself honourably. DISCUSSION: Underlines the pitfalls of basing sweeping conclusions on an imperfectly understood inadequate selection of the available evidence.

[BRILL-ZINSER DISEASE AS A CONSEQUENCE OF RICKETTSIA PROWAZEKII PERSISTENCE IN PREVIOUSLY ILL WHO HAVE HAD EPIDEMIC TYPHUS (EPIDEMIOLOGIC ASPECTS)].

Materials, that summarize data of original research and scientific literature on epidemiology and problems of persistence during epidemic typhus, whose causative agent (Rickettsia prowazekii) is reactivated in the organism of the previously ill and is manifested as Brill-Zinser disease, are presented. A retrospective analysis was carried out with the data obtained by Russian (All-Union) Centre for Rickettsioses during study of epidemiologic examination maps of 5705 typhus nidi and results of 19 463 blood sera analysis during study of immunologic structure of population in the territories of the former USSR for the period from 1970 to 1992. A decrease of epidemic typhus morbidity and an increase of the fraction of Brill-Zinser disease took place as a result of pediculosis corporis control. In separate territories specific weight of Brill-Zinser disease was 48% in 1952, up to 80% in 1969, and from 1977 all the ill were previously ill. However, during the perestroika period and afterwards, due to a reduction of economic and hygienic living conditions, appearance of refugees, the immune structure regarding typhus began to change. Due to the buildup of the population migration process and the presence of risk groups (refugees, homeless) among population of regions, where local wars are waged, the enhancement of methods of epidemic typhus and Brill-Zinser disease diagnostics and pediculosis corporis eradication is necessary. Study of R. prowazekii by molecular-genetics methods is necessary for complete understanding of its mechanism of persistence.

Inactivation of SAM-methyltransferase is the mechanism of attenuation of a historic louse borne typhus vaccine strain.

Louse borne typhus (also called epidemic typhus) was one of man's major scourges, and epidemics of the disease can be reignited when social, economic, or political systems are disrupted. The fear of a bioterrorist attack using the etiologic agent of typhus, Rickettsia prowazekii, was a reality. An attenuated typhus vaccine, R. prowazekii Madrid E strain, was observed to revert to virulence as demonstrated by isolation of the virulent revertant Evir strain from animals which were inoculated with Madrid E strain. The mechanism of the mutation in R. prowazekii that affects the virulence of the vaccine was not known. We sequenced the genome of the virulent revertant Evir strain and compared its genome sequence with the genome sequences of its parental strain, Madrid E. We found that only a single nucleotide in the entire genome was different between the vaccine strain Madrid E and its virulent revertant strain Evir. The mutation is a single nucleotide insertion in the methyltransferase gene (also known as PR028) in the vaccine strain that inactivated the gene. We also confirmed that the vaccine strain E did not cause fever in guinea pigs and the virulent revertant strain Evir caused fever in guinea pigs. We concluded that a single nucleotide insertion in the methyltransferase gene of R. prowazekii attenuated the R. prowazekii vaccine strain E. This suggested that an irreversible insertion or deletion mutation in the methyl transferase gene of R. prowazekii is required for Madrid E to be considered a safe vaccine.

Discovery of a protective Rickettsia prowazekii antigen recognized by CD8+ T cells, RP884, using an in vivo screening platform.

Rickettsia prowazekii has been tested for biological warfare due to the high mortality that it produces after aerosol transmission of very low numbers of rickettsiae. Epidemic typhus, the infection caused by these obligately intracellular bacteria, continues to be a threat because it is difficult to diagnose due to initial non-specific symptoms and the lack of commercial diagnostic tests that are sensitive and specific during the initial clinical presentation. A vaccine to prevent epidemic typhus would constitute an effective deterrent to the weaponization of R. prowazekii; however, an effective and safe vaccine is not currently available. Due to the cytoplasmic niche of Rickettsia, CD8(+) T-cells are critical effectors of immunity; however, the identification of antigens recognized by these cells has not been systematically addressed. To help close this gap, we designed an antigen discovery strategy that uses cell-based vaccination with antigen presenting cells expressing microbe's proteins targeted to the MHC class I presentation pathway. We report the use of this method to discover a protective T-cell rickettsial antigen, RP884, among a test subset of rickettsial proteins.

Directed mutagenesis of the Rickettsia prowazekii pld gene encoding phospholipase D.

Rickettsia prowazekii, the causative agent of epidemic typhus, is an obligately intracytoplasmic bacterium, a lifestyle that imposes significant barriers to genetic manipulation. The key to understanding how this unique bacterium evades host immunity is the mutagenesis of selected genes hypothesized to be involved in virulence. The R. prowazekii pld gene, encoding a protein with phospholipase D activity, has been associated with phagosomal escape. To demonstrate the feasibility of site-directed knockout mutagenesis of rickettsial genes and to generate a nonrevertible vaccine strain, we utilized homologous recombination to generate a pld mutant of the virulent R. prowazekii strain Madrid Evir. Using linear DNA for transformation, a double-crossover event resulted in the replacement of the rickettsial wild-type gene with a partially deleted pld gene. Linear DNA was used to prevent potentially revertible single-crossover events resulting in plasmid insertion. Southern blot and PCR analyses were used to confirm the presence of the desired mutation and to demonstrate clonality. While no phenotypic differences were observed between the mutant and wild-type strains when grown in tissue culture, the pld mutant exhibited attenuated virulence in the guinea pig model. In addition, animals immunized with the mutant strain were protected against subsequent challenge with the virulent Breinl strain, suggesting that this transformant could serve as a nonrevertible, attenuated vaccine strain. This study demonstrates the feasibility of generating site-directed rickettsial gene mutants, providing a new tool for understanding rickettsial biology and furthering advances in the prevention of epidemic typhus.

Control of typhus fever in Finland during World War II.

The article describes the measures taken against the threat of typhus epidemic in Finland during the Second World War. Comparisons between countries at war and their different typhus prevention methods are made. The main method of typhus prevention in Finland consisted of regular sauna bathing, which was culturally acceptable and very efficient when combined with heating of the clothing. The Finnish troops remained virtually louse-free by ecological and traditional methods, and thus the spread of typhus fever in the army could be prevented.

[The role of Turkish physicians in the vaccination against typhus during the years of World War I]. / I. dünya savasi yillarinda tifüs asisinin uygulanmasinda turk hekimlerinin rolü.

During the years of World War I, several severe typhus epidemics were seen in Erzurum and nearby cities. A total of 164 health officers, 125 of whom were physicians, struggled against the epidemic in the region but also they lost their lives due to typhus. Vaccination against typhus was one of the means of fighting the epidemic. However, there were some claims that a small group of Turkish physicians injected typhus-contaminated serum into Armenian civilians during World War I, and that this should be accepted as a form of biological warfare against Armenian civilians. The purpose of this article is to set out how, by whom, and on whom, and under what conditions the typhus vaccination was applied in order to reveal the truth in terms of the evidence found in historical documents. The typhus vaccine was prepared from blood taken from febrile patients affected by the disease. After the blood of the patients were defibrinated and inactivated at 60 degrees C for an hour, it was used. As the amount of blood needed to prepare the vaccine was so great, the amount of available vaccine was always insufficient to meet the demand. Hence, the prepared vaccine was only applied to those which had the higher risk of contracting typhus such as physicians and nurses. The vaccine prepared by The Third Army Health Commander Dr. Tevfik Salim was first applied to nine officers, five of whom were physicians, and among whom were Dr. Haydar Cemal and Dr. Salahattin on March 28, 1915 in Hasankale, Erzurum. Furthermore, the same vaccine was applied to people in the vicinity by Dr. Alaattin in Erzurum, Dr. Abdulhalim Asim in Bayburt, Dr. Izak in Sivas and Dr. Mihran in Hasankale. Ali Ihsan Sabis and Fevzi Cakmak, who were high ranking officers, were among those who volunteered to have the vaccination. The Third Army Health Commander Dr. Tevfik Salim ordered that the vaccine should not be applied without blood inactivation. Despite this order, Dr. Hamit Osman, who had a mental illness, applied the vaccination without inactivating the blood to some people. Among those were physicians of the Red Crescent Hospital together with soldiers who were nursing in the hospitals in Erzincan. Dr. Hamdi Suat inactivated the blood by leaving it at -16 degrees C for 24-48 hours, and instead of giving a single dose, he applied three-doses with 3-day-intervals, followed by a one more dose, which he called "the vaccine for absolute immunization" to the same people after 10-23 days. This "vaccine for absolute immunization" was actually typhus-contaminated blood which had not been inactivated. It should be noted that he injected himself with the same form of vaccine. In his article published in German in 1916 and in Turkish in 1917, he stated that he injected "the vaccine for absolute immunization" to some subjects 'condemned to death'. Dr. Haydar Cemal claimed, in a newspaper dated December 23, 1918, that the people reported as subjects 'condemned to death' were indeed Armenians, and that the innocent Armenians marked out for deportation were inoculated with the blood of typhus fever patients, and that he eyewitnessed all these events. As a result of his claims, the Interior Ministry demanded an immediate investigation, and at the end of that investigation it was understood that Dr. Haydar Cemal and Dr. Hamdi Suat had never worked together in Erzincan at the time Dr. Haydar Cemal claimed. All the claims were refuted by the investigating committee and nobody was charged. During a severe typhus epidemic, Turkish physicians injected the typhus vaccine for the purpose of "saving a life from the fire". The typhus vaccine was prepared using the available scientific knowledge of the time. No racial or religious discrimination against the people vaccinated had been proved. According to the sources, the claim that some Turkish physicians used the blood of patients with typhus as a means of biological warfare does not reflect the historical truth.