Public health priority: High
PHU response time: Respond to confirmed cases within 1 day of notification. Enter confirmed cases on NCIMS within 1 working day.
Case management: Determine the likely source of infection. Isolate until de-lousing has occurred, if required.
Contact management: Contacts should be placed under surveillance for 15 days after application of an insecticide with residual effect.
A person with clinical typhus and serologically positive tests for Rickettsia prowazekii antibody.
Typhus is to be notified by:
Only confirmed cases should be entered onto NCIMS.
The rickettsia Rickettsia prowazekii.
Typhus is transmitted to humans by infected lice.
The typical incubation period is 7 to 14 days, commonly 12 days. Typhus is not directly transmitted from person to person. Cases are infective to lice during the febrile illness and possibly for 2 to 3 days after the temperature returns to normal.
The usual clinical presentation has a variable onset, often with fever, headache, chills, prostration and general pains. A macular eruption appears on the fifth to sixth day, initially on the upper trunk, followed by spread to the whole body, sparing the face, palms and soles. Toxaemia is usually pronounced. Case-fatality rate increases with increasing age and can reach 40 per cent.
On same day of notification of a case begin follow-up investigation.
Within 1 working day of notification enter confirmed cases on NDD.
The response to a notification will normally be carried out in collaboration with the case's health carers. Regardless of who does the follow-up, PHU staff should ensure that action has been taken to:
Attempt to identify the source of infection, such as a location visited and exposures during any recent overseas travel or poor living conditions or any environment where exposure to body lice is likely. Isolate the patient until de-lousing has occurred, if required.
Tetracyclines or chloramphenicol are recommended therapies.
The case or relevant care-giver should be informed about the nature of the infection and the mode of transmission and the reason for and duration of isolation. Provide the Typhus fact sheet.
Isolation is required until the case, clothing, living quarters and household contacts are shown to be lice free.
The actual or probable source of infection must be determined and preventive measures undertaken. Delousing of clothing, bedding and living quarters is necessary.
A person exposed to an infected case or environment before de-lousing, particularly in households and institutions.
Assess for louse infestation and de-louse where necessary.
Advise susceptible contacts (or parents/guardians) of the risk of infection. Provide the Typhus fact sheet.
Louse-infested susceptible persons exposed to typhus fever should be placed under surveillance (i.e. contacted daily by the PHU for evidence of illness) for 15 days after application of an insecticide with residual effect.