Since 1914, many troops, prisoners and even doctors were infected, and at least 150,000 died from typhus in Serbia, 50,000 of whom were prisoners. Delousing stations were established for troops on the Western Front, but the disease ravaged the armies of the Eastern Front. Fatalities were generally between 10 and 40 percent of those infected, and the disease was a major cause of death for those nursing the sick. During World War I and the Russian Civil War between the White and Red, the typhus epidemic caused 2–3 million deaths out of 20–30 million cases in Russia between 1918 and 1922. Typhus caused hundreds of thousands of deaths during World War II. It struck the German Army during Operation Barbarossa, the invasion of Russia, in 1941. In 1942 and 1943 typhus hit French North Africa, Egypt and Iran particularly hard. Typhus epidemics killed inmates in the Nazi concentration camps and death camps such as Auschwitz, Dachau, Theresienstadt, and Bergen-Belsen. Footage shot at Bergen-Belsen concentration camp shows the mass graves for typhus victims. Anne Frank, at age 15, and her sister Margot both died of typhus in the camps. Even larger epidemics in the post-war chaos of Europe were averted only by the widespread use of the newly discovered DDT to kill lice on the millions of refugees and displaced persons.Following the development of a vaccine during World War II, Western Europe and North America have been able to prevent epidemics. These have usually occurred in Eastern Europe, the Middle East, and parts of Africa, particularly Ethiopia.
The same risk applies to refugees, who travel across country lines, often living in close proximity and unable to maintain necessary hygienic standards to avoid being at risk for catching lice possibly infected with typhus.Because the typhus-infected lice live in clothing, the prevalence of typhus is also affected by weather, humidity, poverty and lack of hygiene. Lice, and therefore typhus, are more prevalent during colder months, especially winter and early spring. In these seasons, people tend to wear multiple layers of clothing, giving lice more places to go unnoticed by their hosts. This is particularly a problem for poverty-stricken populations as they often do not have multiple sets of clothing, preventing them from practicing good hygiene habits that could prevent louse infestation.Due to fear of an outbreak of epidemic typhus, the US Government put a typhus quarantine in place in 1917 across the entirety of the US-Mexican border. Sanitation plants were constructed that required immigrants to be thoroughly inspected and bathed before crossing the border. Those who routinely crossed back and forth across the border for work were required to go through the sanitation process weekly, updating their quarantine card with the date of the next weeks sanitation. These sanitation border stations remained active over the next two decades, regardless of the disappearance of the typhus threat. This fear of typhus and resulting quarantine and sanitation protocols dramatically hardened the border between the US and Mexico, fostering scientific and popular prejudices against Mexicans.