CONTRIBUTION TO THE UNDERSTANDING OF THE HEALTH SITUATION WITHIN THE POPULATION IN SLAVONIA AND SRIJEM DURING THE SECOND WORLD WAR WITH AN EMPHASIS ON INFECTIOUS DISEASES / Prilog poznavanju zdravstvenih prilika stanovnistva u Slavoniji i Srijemu tijekom Drugoga svjetskog rata, s naglaskom na zarazne bolesti

During World War II, the population of agricultural areas of Slavonia and Srijem lived in privation, but there was no famine. A more serious threat was infectious diseases, such as malaria, typhoid fever, and dysentery, which were also present within the population in the post-war period. Major epidemics broke out mostly in areas under partisan control, especially in the areas of western and central Slavonia, where major epidemic typhus contagious broke out. Venereal diseases, less common in the Slavonian area before the war, were also on the rise. Two factors had an impact on the health situation within the population ­ state medical institutions and partisan medical corps. Health care and measures to combat infectious diseases were provided by state authorities, and that is still an insufficiently explored area in historiography. During the first years of the war, the partisan medical corps personnel, initially mostly semiskilled and lacking necessary medical equipment and medications, relied on the support from the population to a greater extent than they were able to provide medical care to them. With the arrival of professional staff and the acquisition of medicines and medical equipment, mainly sourced from medical institutions in areas under partisan control, they assumed a more active role in supporting civilian authorities under the "people's rule"­specifically, the people's liberation committees. Their focus shifted to healthcare for the civilian population, primarily aimed at suppressing and preventing infectious diseases. Further research on this topic will contribute to a more realistic perception of the civilian population's everyday life during the war, which was presented in memoir literature and historiography of the socialist period as a heroic act of resistance rather than a struggle for survival in the conditions of privation and diseases; it will also complete the picture of the human losses of the civilian population caused by infectious diseases.

Increasingly limited options for the treatment of enteric fever in travellers returning to England, 2014-2019: a cross-sectional analytical study.

Introduction. Enteric fever (caused by Salmonella enterica serovars Typhi and Paratyphi) frequently presents as an acute, undifferentiated febrile illness in returning travellers, requiring timely empirical antibiotics.Gap Statement. Determining which empirical antibiotics to prescribe for enteric fever requires up-to-date knowledge of susceptibility patterns.Aim. By characterising factors associated with antimicrobial resistance in cases of S. Typhi and S. Paratyphi imported to England, we aim to guide effective empirical treatment.Methodology. All English isolates of S. Typhi and S. Paratyphi 2014-2019 underwent antimicrobial susceptibility testing; results were compared to a previous survey in London 2005-2012. Risk factors for antimicrobial resistance were analysed with logistic regression models to predict adjusted odds ratios (aOR) for resistance to individual antibiotics and multi-drug resistance.Results. We identified 1088 cases of S. Typhi, 729 S. Paratyphi A, 93 S. Paratyphi B, and one S. Paratyphi C. In total, 93 % were imported. Overall, 90 % of S. Typhi and 97 % of S. Paratyphi A isolates were resistant to ciprofloxacin; 26 % of S. Typhi were multidrug resistant to ciprofloxacin, amoxicillin, co-trimoxazole, and chloramphenicol (MDR+FQ). Of the isolates, 4 % of S. Typhi showed an extended drug resistance (XDR) phenotype of MDR+FQ plus resistance to third-generation cephalosporins, with cases of XDR rising sharply in recent years (none before 2017, one in 2017, six in 2018, 32 in 2019). For S. Typhi isolates, resistance to ciprofloxacin was associated with travel to Pakistan (aOR=32.0, 95 % CI: 15.4-66.4), India (aOR=21.8, 95 % CI: 11.6-41.2), and Bangladesh (aOR=6.2, 95 % CI: 2.8-13.6) compared to travel elsewhere, after adjusting for rising prevalence of resistance over time. MDR+FQ resistance in S. Typhi isolates was associated with travel to Pakistan (aOR=3.5, 95 % CI: 2.4-5.2) and less likely with travel to India (aOR=0.07, 95 % CI 0.04-0.15) compared to travel elsewhere. All XDR cases were imported from Pakistan. No isolate was resistant to azithromycin. Comparison with the 2005-2012 London survey indicates substantial increases in the prevalence of resistance of S. Typhi isolates to ciprofloxacin associated with travel to Pakistan (from 79-98 %) and Africa (from 12-60 %).Conclusion. Third-generation cephalosporins and azithromycin remain appropriate choices for empirical treatment of enteric fever in most returning travellers to the UK from endemic countries, except from Pakistan, where XDR represents a significant risk.

THE TERMINAL APHONIA OF ALEXANDER THE GREAT, A SILENT HERALD OF AN ORDINARY DEATH

Even though the absence of the body prevents sure conclusions, the death of Alexander the Great remains a hot topic of retrospective diagnosis. Due to the serious mishandling of ancient sources, the scientific literature had Alexander dying of every possible natural cause. In previous works, the hypothesis that typhoid fever killed Alexander was proposed, based on the presence of the remittent fever typical of this disease in the narrations of Plutarch and Arrian. Here we provide additional evidence for the presence of stupor, the second distinctive symptom of typhoid fever. In fact, based on the authority of Caelius Aurelianus and Galen, we demonstrate that the word ἄφωνος, used to describe the last moments of Alexander, is a technical word of the lexicon of the pathology of Hippocrates. Used by him, the word defines a group of diseases sharing a serious depression of consciousness and motility. The association of stupor with the remittent fever strengthens the typhoid fever hypothesis.

De asilo a hospital dos tifosos: o caso do asilo António Almeida da Costa na primeira metade do século XX. Génese, dinâmicas e funcionalidades / From asylum to a typhous hospital: the case of the asylum António Almeida da Costa in the first half of the twentieth century. Genesis, dynamics and functionalities

O presente trabalho tem como objetivos principais analisar a génese, as dinâmicas e as funcionalidades do Asilo António Almeida da Costa, fundado no início do século XX em Vila Nova de Gaia, localidade perto da cidade do Porto, no norte de Portugal, na assistência na velhice, inicialmente idealizada para os velhos operários do complexo industrial de Cerâmica e de Fundição das Devesas, e na sua iniciativa pontual: a transformação num hospital dos Tifosos aquando a epidemia que se fez sentir na cidade. Para responder a estes objetivos efectuou-se um exercício de reconstrução histórica através do acervo do benemérito, nomeadamente com base nas atas da comissão administrativa, nos regulamentos e estatutos internos e, também, no livro de inválidos internados no Asilo. Com base na informação encontrada foi possível descrever as dinâmicas da instituição na assistência à velhice, em especial no lugar das Devesas em Vila Nova de Gaia, enquadrando o importante contributo da mesma na causa pública do combate à epidemia do tifo exantemático

This work aims to analyse the genesis, dynamics and functionalities of the António Almeida da Costa Asylum, founded at the beginning of the 20th century in Vila Nova de Gaia, in northern Portugal, in the elderly assistance, initially funded for the elderly workers of the industrial complex of Ceramics and Foundry of Devesas, and in their punctual initiative: the transformation into a hospital for the Typhosos when the epidemic occurred in the city. To meet these objectives, a historical reconstruction exercise was carried out through the benemerit acquis, in particular, based on the minutes of the administrative committee, in internal regulations and statutes and also in the book of invalids hospitalized in the Asylum. Based on the information found, it was possible to describe the institution's dynamics in the assistance to the elderly, especially in the place of the Devesas in Vila Nova de Gaia, framing the important contribution of it in the public cause of the fight against the exanthematic typhus epidemic

No disponible

Salmonella Typhi - historical perspective of discovery and forgotten contribution of Polish anatomopathology.

Outbreaks of typhoid fever for centuries decimated armies, cities and large hosts of people. Discovery of an agent causing such a grave disease became one of the most important achievements of bacteriology - science, which had experienced rapid development in the last quarter of the 19th century and changed the course of our civilization.The article deals with the discovery of Tadeusz Browicz, Polish anatomopathologist, who in 1874 reported about rod-shaped "parasites" in viscera of typhoid fever victim. His achievement became shaded by the later discoveries of Eberth, Klebs and Gaffky, but as authors stated below, Browicz should be recognized with mentioned scientists as a co-discoverer of the typhoid fever bacillus.

Alexandroupolis (Dedeagatch): A city born of infections and the first documented death of the Italian civilian Giuseppe Bigheti.

The choice of Dedeagatch as the place where the station of the Adrianoupolis-Constantinople railway line was to be built was the reason for the foundation of the Greek city of Alexandroupolis (originally under the Ottoman government). The population grew in its early years mainly due to the settlement by railway and construction workers. Meanwhile, poverty, poor hygiene and environmental conditions led to a series of epidemics and various sporadic cases of infections such as malaria, typhoid fever, scarlet fever and tubercolosis, infections which marked the early history of Alexandroupolis. The first documented death due to typhoid fever in the area, namely that of the Italian civilian Giuseppe Bigheti, is mentioned in the paper.

Changes in historical typhoid transmission across 16 U.S. cities, 1889-1931: Quantifying the impact of investments in water and sewer infrastructures.

Investments in water and sanitation systems are believed to have led to the decline in typhoid fever in developed countries, such that most cases now occur in regions lacking adequate clean water and sanitation. Exploring seasonal and long-term patterns in historical typhoid mortality in the United States can offer deeper understanding of disease drivers. We fit modified Time-series Susceptible-Infectious-Recovered models to city-level weekly mortality counts to estimate seasonal and long-term typhoid transmission. We examined seasonal transmission separately by city and aggregated by water source. Typhoid transmission peaked in late summer/early fall. Seasonality varied by water source, with the greatest variation occurring in cities with reservoirs. We then fit hierarchical regression models to measure associations between long-term transmission and annual financial investments in water and sewer systems. Overall historical $1 per capita ($16.13 in 2017) investments in the water supply were associated with approximately 5% (95% confidence interval: 3-6%) decreases in typhoid transmission, while $1 increases in the overall sewer system investments were associated with estimated 6% (95% confidence interval: 4-9%) decreases. Our findings aid in the understanding of typhoid transmission dynamics and potential impacts of water and sanitation improvements, and can inform cost-effectiveness analyses of interventions to reduce the typhoid burden.

El binomio miseria-enfermedad: un estudio sociohistórico y legislativo sobre las fiebres tifoideas en España (1886-1930) desde la Historia de la salud / The misery-disease binomial: a socio-historical and legislative study on typhoid fevers in Spain (1886-1930) from de History of health / O binômio miséria-doença: um estudo sócio-histórico e legislativo sobre a febre tifóide na Espanha (1886-1930) da História da saúde

La fiebre tifoidea es una enfermedad que mantiene a lo largo del siglo XX un carácter social, relacionado con las guerras y las desigualdades económicas. Fue objeto de una respuesta legislativa del Estado, que desde finales del siglo XIX hasta 1930, sistematizó la ciencia contra las fiebres tifoideas y su vacunación en forma de grandes campañas cuyo resultado fue la progresiva disminución de incidencia, morbilidad y mortalidad hasta su práctica erradicación. La investigación que nos ocupa se refiere a un estudio sociohistórico y legislativo de la enfermedad hasta finales de los años 20 del siglo XX en España

Typhoid fever is a disease that maintains a social character throughout the 20th century, related to wars and economic inequalities. It was the subject of a legislative response from the State, which from the end of the 19th century until 1930, systematized science against typhoid fevers and their vaccination in the form of large campaigns whose result was the progressive decrease in incidence, morbidity and mortality until its eradication practice. The research that concerns us refers to a socio-historical and legislative study of the disease until the late 20s of the 20th in Spain

A febre tifóide é uma doença que mantém caráter social ao longo do século XX, relacionada a guerras e desigualdades econômicas. Foi objeto de uma resposta legislativa do Estado, que desde o final do século XIX até 1930, sistematizou a ciência contra a febre tifóide e sua vacinação na forma de grandes campanhas cujo resultado foi a diminuição progressiva da incidência, morbidade e mortalidade até sua prática de erradicação. A pesquisa que nos preocupa refere-se a um estudo sócio-histórico e legislativo da doença até o final dos anos 20 do século XX na Espanha

Typhoid-From Past to Future.

Making a Difference? brings together medical humanities and sciences experts to analyze how historical and new data on typhoid control can be brought to bear on the current context of typhoid conjugate vaccine rollouts and extensively drug-resistant typhoid.

A Biohistorical Perspective of Typhoid and Antimicrobial Resistance.

We combine methodology from history and genetics to reconstruct the biosocial history of antimicrobial resistance (AMR) in the bacterium Salmonella enterica serovar Typhi (S. Typhi). We show how evolutionary divergence in S. Typhi was driven by rising global antibiotic use and by the neglect of typhoid outside of high-income countries. Although high-income countries pioneered 1960s precautionary antibiotic regulations to prevent selection for multidrug resistance, new antibiotic classes, typhoid's cultural status as a supposedly ancient disease of "undeveloped" countries, limited international funding, and narrow biosecurity agendas helped fragment effective global collective action for typhoid control. Antibiotic-intensive compensation for weak water and healthcare systems subsequently fueled AMR selection in low- and middle-income countries but often remained invisible due to lacking surveillance capabilities. The recent rise of extensively drug-resistant typhoid bears the biosocial footprint of more than half a century of antibiotic-intensive international neglect.

[The uncomfortable history of Mary Mallon and typhoid fever]. / De ongemakkelijke geschiedenis van Mary Mallon en de buiktyfus.

Mary Mallon (1869-1938) was an Irish immigrant who worked as a cook for rich families in New York. She was responsible for several outbreaks of typhoid fever since she was an asymptomatic carrier of Salmonella typhi. Because of the danger and fear for new outbreaks, she was held in quarantine for years, against her will. What factors contributed to this decision? Was it necessary to keep her isolated? And what was the role of public opinion and media? The history of Mary Mallon is a sad and tragic chapter in medical history, from which we can still draw important lessons.

[Thomas Mann and infectious diseases in the first half of the 20th century. Part I: Typhoid fever, meningitis and syphilis]. / Thomas Mann y las enfermedades infecciosas en la primera mitad del siglo XX. Parte I: Fiebre tifoidea, meningitis y sífilis.

Surely, Thomas Mann is today a forgotten writer, with only a little and precious group of readers between our young colleagues. However, perhaps could be useful for the others some knowledge about his vision of the infectious diseases in the first half of the twentieth century, when he wrote the novels here reviewed. Typhoid fever, meningitis, tuberculosis, syphilis and cholera are present in Mann's thematic from Buddenbrooks till Doktor Faustus, always with a personal focus, more on spirit -the will to live - rather than on flesh and bones… or bacteria. One of his later and minor works let us throw an ironical glance over transplant, no so named, indeed, by Mann, who speaks of "exchange". In this first part we present typhoid fever, meningitis and syphilis.

Direct Medical Costs of 3 Reportable Travel-Related Infections in Ontario, Canada, 2012-2014.

Immigrants traveling to their birth countries to visit friends or relatives are disproportionately affected by travel-related infections, in part because most preventive travel health services are not publicly funded. To help identify cost-effective policies to reduce this disparity, we measured the medical costs (in 2015 Canadian dollars) of 3 reportable travel-related infectious diseases (hepatitis A, malaria, and enteric fever) that accrued during a 3-year period (2012-2014) in an ethnoculturally diverse region of Canada (Peel, Ontario) by linking reportable disease surveillance and health administrative data. In total, 318 case-patients were included, each matched with 2 controls. Most spending accrued in inpatient settings. Direct healthcare spending totaled $2,058,196; the mean attributable cost per case was $6,098 (95% CI $5,328-$6,868) but varied by disease (range $4,558-$7,852). Costs were greatest for enteric fever. Policies that address financial barriers to preventive health services for high-risk groups should be evaluated.

The Greater Good: Agency and Inoculation in the British Army, 1914-18.

As the First World War progressed, rates of typhoid diminished. This was heralded as a triumph of sanitary improvement and disease protection; yet as to how the British military achieved this remains a contentious issue. Objections arose around the danger of inoculation and the unpleasant and potentially deadly side effects. Between the unaffected and the sufferers of the vaccine's side effects are the unexplored stories of the refusers. Often bizarre, their accounts include stories of unsanctioned cajoling, arrests, suspension of privileges, and even physically forced inoculation. Soldiers could be encouraged, convinced, and, in rare cases, even forced to undergo inoculation. For others, the opportunity to refuse was often not made clear, as inoculation became part of routine military life. Despite the fact that soldiers were supposed to have complete autonomy over their own inoculation, the reality was often different. Penalties for noncompliance and a lack of clarification about soldiers' rights demonstrated that throughout the war a clash developed between individual autonomy and an authoritarian regime determined to ensure the health of its fighting force.

Epidemiological Trend of Typhoid and Paratyphoid Fevers in Zhejiang Province, China from 1953 to 2014.

Background: The incidences of typhoid and paratyphoid remain high and these diseases still pose a public health problem in China and in Zhejiang Province in particular. This study aimed to investigate the trend of typhoid and paratyphoid in Zhejiang Province from 1953 to 2014 and to provide a theoretical basis for the prevention and control of these diseases. Methods: Included in this study were compiled epidemiological data of typhoid and paratyphoid cases in Zhejiang from 1953 to 2003 and epidemiological data of those from 2004 to 2014 registered in the China Information System for Diseases Control and Prevention. Description methods were employed to explore the epidemiological characteristics, including long-term trend, gender distribution, age distribution, and occupation distribution. Incidence maps were made to represent the annual average incidences for each municipality. Spearman's rank correlation was performed to detect the correlation between incidence and average elevation, and circular distribution was calculated to identify the seasonality and peak days of the diseases. A p-value of <0.05 was considered statistically significant. Results: A total of 182,602 typhoid and paratyphoid cases were reported in Zhejiang Province from 1953 to 2014, and the average annual incidence was 7.89 per 100,000 population. The incidence in 2014 decreased by 93.82% compared with that in 1953 and by 95.00% compared with the highest incidence rate. The average incidence before 2003 was negatively correlated with the average elevation of each region in Zhejiang province (r < 0, p < 0.05), but there was no statistically significant correlation from 2003. The peak period of diseases fell in the months from April to October every year. The incidence among the population group aged over 35 rose gradually but declined sharply among those between 20 and 34. Conclusions: The incidence of typhoid and paratyphoid decreased in Zhejiang Province from 1953 to 2014 but remained high in some regions. Proper measures for prevention and control are warranted in the southeast coast areas and for high-risk populations.

Edward Ballard and the Practice of Epidemiology in the 19th-Century United Kingdom.

This article recovers the history of Victorian epidemiology through the career of British physician Edward Ballard (1820-1897). Ballard's career provides a useful window into the practices of epidemiology in the 19th century because he held notable public health posts as medical officer of health for Islington and inspector at the Medical Department of the Local Government Board. By the time of his death, in 1897, he typified the transition toward professional epidemiology. In exploring some of the most important environmental and health-related problems in preventive medicine in the 19th century, Ballard was part of a group of influential epidemiologists who studied infectious disease. In particular, he was noted for his research into typhoid fever and industrial health. Yet Ballard's career has largely been forgotten. In this article, I explore Ballard's work as a window into the everyday practices of Victorian epidemiology and suggest that the process of professionalizing epidemiology in the 20th century was about forgetting epidemiology's Victorian past as much as it was about championing it.

Lessons Learned from Emergency Response Vaccination Efforts for Cholera, Typhoid, Yellow Fever, and Ebola.

Countries must be prepared to respond to public health threats associated with emergencies, such as natural disasters, sociopolitical conflicts, or uncontrolled disease outbreaks. Rapid vaccination of populations vulnerable to epidemic-prone vaccine-preventable diseases is a major component of emergency response. Emergency vaccination planning presents challenges, including how to predict resource needs, expand vaccine availability during global shortages, and address regulatory barriers to deliver new products. The US Centers for Disease Control and Prevention supports countries to plan, implement, and evaluate emergency vaccination response. We describe work of the Centers for Disease Control and Prevention in collaboration with global partners to support emergency vaccination against cholera, typhoid, yellow fever, and Ebola, diseases for which a new vaccine or vaccine formulation has played a major role in response. Lessons learned will help countries prepare for future emergencies. Integration of vaccination with emergency response augments global health security through reducing disease burden, saving lives, and preventing spread across international borders.

Algunas notas sobre el desarrollo histórico de la fiebre tifoidea en Chile / Some information regarding the historical development of typhoid fever in Chile

Resumen En el desarrollo histórico de la fiebre tifoidea en Chile, destaca su confusión con otras patologías infecciosas, especialmente con el tifus exantemático, problema que se resolvió mayormente con ocasión de la epidemia de 1918 de dicha enfermedad. Además se resalta la importancia del tratamiento con cloranfenicol, que significó una mejoría extraordinaria de las fiebres tifo-paratíficas, además de las acciones de salud pública y educación sanitaria, que permitieron prácticamente terminar con dichas patologías infecciosas en el país.

During the historical development of typhoid fever in Chile, its confusion with other infectious diseases is particularly noteworthy, especially with murine typhus, a problem that was mainly resolved during the 1918 epidemic. The importance of chloramphenicol treatment is also highlighted, which meant an enormous improvement in typhoid/paratyphoid fevers, in combination with public health and health education actions that allowed to almost eliminate these infectious diseases in our country.