Typhoid fever historical perspective

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Aslam, M.B.B.S[2]

Overview

Around 430–426 B.C., a devastating plague, which some believe to have been typhoid fever, killed one-third of the population of Athens, including Pericles, the state's leader. A 2006 study detected DNA sequences similar to those of the bacterium responsible for typhoid fever in a DNA sample dating back to the time of the epidemic. Other scientists have disputed the findings, citing serious methodologic flaws in the dental pulp-derived DNA study.

The most notorious carrier of typhoid fever—though by no means the most destructive—was Mary Mallon, also known as Typhoid Mary. In 1907, Mallon became the first American carrier to be identified and traced. She was a cook in New York who was believed to be the source of infection for several hundred people. She is closely associated with forty-seven cases of the illness and three deaths.

In 1897, Almroth Edward Wright developed an effective vaccine for typhoid fever. Antibiotics were introduced in clinical practice in 1942, greatly reducing mortality.

Historical Perspective

• Around 430–426 B.C., a devastating plague, which some believe to have been typhoid fever, killed one-third of the population of Athens, including Pericles, the state's leader. This enabled the balance of power in the region to shift from Athens to Sparta, ending the Golden Age of Pericles that had marked Athenian dominance in the ancient world.
• Ancient historian Thucydides also contracted the disease, but he survived to write about the plague. His writings are the primary source of information about this outbreak.
• The cause of the plague has long been disputed, with modern academics and medical scientists considering epidemic typhus the most likely cause. However, a 2006 study detected DNA sequences similar to those of the bacterium responsible for typhoid fever.
  • Other scientists have disputed the findings, citing serious methodologic flaws in the dental pulp-derived DNA study. The disease is most commonly transmitted through poor hygiene habits and public sanitation conditions; during the period in question, the whole population of Attica was besieged within the Long Walls and lived in tents.

• In the late 19th century, typhoid fever mortality rate in Chicago averaged 65 per 100,000 people a year. The worst year was 1891, when the typhoid death rate was 174 per 100,000 persons.
• The most notorious carrier of typhoid fever—though by no means the most destructive—was Mary Mallon, also known as Typhoid Mary. In 1907, she became the first American carrier to be identified and traced. She was a cook in New York and the source of infection for several hundred people. She is closely associated with forty-seven cases and three deaths. Public health authorities told Mary to give up working as a cook or have her gall bladder removed. Mary quit her job but returned later under a false name. She was detained and quarantined after another typhoid outbreak. She died of pneumonia after 26 years in quarantine.
• In 1897, Almroth Edward Wright developed an effective vaccine.
• Most developed countries saw declining rates of typhoid fever throughout first half of 20th century due to vaccinations and advances in public sanitation and hygiene. Antibiotics were introduced in clinical practice in 1942, greatly reducing mortality. At the present time, incidence of typhoid fever in developed countries is around 0.5 cases per 100,000 people per year.
• An outbreak in the Democratic Republic of Congo in 2004-05 recorded more than 42,000 cases and 214 deaths.