against murine typhus in sera from Indonesians*

P. F. D. VAN PEENEN Department of Preventive Medicine, Unifarmed Services University of Health Sciences, Bethesda, Maryland, C. KOESHARJONO Ministry of Health, Jakarta, Indonesia R. SEE, A. L. BOURGEOISAND G. S. IRVING U.S. Naval Medical Research Unit No. 2, Box 14, APO San Francisco 96263, U.S.A.

A sero-epidemiological study of human CF and indirect immunofluorescence antibodies against murine typhus was conducted in Indonesia. Antibody prevalences ranged from 10% to 20% in sera of Indonesians from Java and Sumatra to less than 2% in sera from islands east of Java. Introduction Murine typhus, called urban or shop typhus by colonial Dutch scientists, was recognized as a cause of human disease in Indonesia on the East Coast of Sumatra (KOUWENAAR & WOLFF,1939) and in Jakarta, West Java (WOLFF & DEGRAAF, 1939). According to GISPEN & WARSA (1951), the disease was probably also endemic in other towns and villages of Java. In Jakarta, Rickettsia typhi (=R. mooseri) has been isolated from rats (Rattus norvegicus and R. diardii), fleas (Xenopsylla cheopis), and, surprisingly, mites (Ascoshoengastiu indica) (GISPEN & WARSA, 1951; GISPEN,1950). It has been presumed that murine typhus occurs throughout most of Indonesia (FARNER, 1944). This presumption can now be tested sero-epidemiologically, since measurement of past infection is possible using specific antigens in serologic tests (SHIM1 et al., 1975 ; PHILIP et al., 1976). In the work described in the present report, we studied the distribution of antibodies against murine typhus in human sera collected from widely separated localities in Indonesia. Materials and methods Sera were collected between May 1973 and April 1975





I ,280

Fig. 1. Map of Indonesia showing provinces from which human sera were collected.

20014 U.S.A.

during field studies in various parts of Indonesia. Samples were grouped according to province or island (Fig. 1); the number of persons sampled in each locality is shown in Table I. All donors were ambulatory volunteers who presented themselves for examination at the request of village and public health officials; surveys were usually in rural areas or in or near slaughterhouses in cities. Donors were questioned as to age, sex, occupation, and if they were native to the area, but there was no attempt to collect random or age- or sex-stratified samples (Table I). Most were farmers, slaughterhouse workers, or small ranchers and their families. Blood was obtained by antecubital venepuncture and sera were separated and stored without preservative at -4°C in the field, and at -20°C for periods of one to three years in the laboratory. Serological testing was by CF using antigen supplied by the National Center for Disease Control (NCDC), Atlanta, Georgia and test procedures recommended by the NCDC. There were 146 sera positive at titres of 1:4 or greater by CF. Of these, 142 were available for testing for murine typhus antibodies by the indirect fluorescent antibody test (IFAT) using Rickettsia typhi in yolk sacs as described by PHILIP et al. (1976). 52 additional sera without CF antibodies were also analysed by IFAT, and these 194 sera were tested for scrub typhus antibodies by IFAT using a yolk sac mixture of Karp, Gilliam and Kato strains of R. tsutsugamushi provided by the Microbiology Department, Naval Medical Research Institute, Bethesda, Maryland. Results Criteria for deciding whether antibody levels against murine typhus indicated past infection were based on the distribution of titres in our series as well as on the guidelines reported by others (SHIRAI et al., 1975; GISPEN et al., 1951): a CF titre of 2 1:s and IFAT titre of 2 1:80 were considered positive. There were 76 such sera positive by both tests (Table II). An additional three sera with *This study was supported through funds provided by theNaval Medical Research and Development Command, Navy Department, for Work Unit MF51.524.009~0037. The opinions and assertions contained herein are not to be construed as official or as representing the views of the Indonesian Ministry of Health or the U.S. Navy Department. Reprint requests to Publications Office, NAMRU-2, Box 14, APO San Francisco 96263 or 7-1 Kung Yuan Road. Taipei, Taiwan, Republic of China.



Table I - Sample cha~~er~sti~ Occupation Province or island

TotaI No.



West Sumatra Bengkulu West Java Central Java Bali Timor and Flores Central Sulawesi Muna

33 36 288 147 27 35 78 78

33 31 2.56 143 25 30 76 57

0 5 32 4 2 5 2 21





2 30

Animal contact


9 166 59 7 12 41 53

22 27 122 88 20 23 37 25

33 36 272 139 27 32 42 31

0 0 16 S 0 3 36 47

30 22 134 107 27 29 60 7s

3 14 154 40 0 6 IS 0







Antibodies against murine typhyus in sera from Indonesians.

297 TRANSACTIONSOF THE ROYAL SOCIETYOF TROPICAL MEDICINE AND HYGIENE, VOL. 71, No. 4,1977. Antibodies against murine typhus in sera from Indonesians...
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