California Typhus Outbreak Continues to Grow

Oct. 10, 2018 — Public health officials in Los Angeles are still working to control an outbreak of typhus, a bacterial disease spread by infected fleas, in the downtown area and elsewhere in the sprawling county.

From mid-July until early October, nine cases of typhus have been observed in the downtown area alone, says Sharon Balter, MD, director of the division of communicable disease for the L.A. County Department of Public Health. Downtown Los Angeles has a large population of homeless people, and while all nine patients have a history of living or working in downtown L.A., not all those affected are homeless, she says.



“Homelessness, crowded housing, poor hygiene, poor toiletry habits” all make it more likely to get typhus, says Aaron Glatt, MD, chairman of medicine and hospital epidemiologist for South Nassau Communities Hospital, Oceanside, NY.

While typhus is normally seen throughout the county, that number of cases is unusually high in such a short period of time, she says. From January until early October, 59 cases have been documented. “In 2017, there were 67 cases for the whole year,” Balter says. “So if we continue [seeing cases], we might exceed the number from last year.”

Nearby, Pasadena has reported an additional 20 cases of typhus, up to four times as many as the city typically sees each year.

Typhus is “easily treated with antibiotics,” Balter says. “But people can become very sick if they don’t get prompt treatment.”


About Typhus

The disease in the L.A. outbreak is known as murine typhus and can spread to people from infected feces of fleas. Those feces have bacteria called Rickettsia typhi, according to the CDC.

When these infected feces are rubbed accidentally into scrapes or cuts in the skin, people become sick. In L.A. County, the health department says, typhus infects fleas found on dogs, cats, rats, and opossums. Animals carrying typhus themselves do not get sick.



The disease is not spread from person to person.

Symptoms usually come on within 2 weeks of infection. Those affected report fever, chills, headache, sometime a rash, and nausea and vomiting, he says. The symptoms are vague, and people may mistake them for other problems, such as the flu or other “bugs,” Glatt says.


Blood tests or a skin biopsy can help diagnose the disease, he says.

The CDC says most people will recover without treatment, but some cases may be severe. If left untreated, severe cases can lead to damage in the liver, kidneys, lungs, and brain.

The treatment is a 7- to 10-day course of antibiotics, usually doxycycline, says Glatt, who’s also a spokesman for the Infectious Diseases Society of America. “It’s very cheap” and effective. But it’s best if typhus is caught early. The disease is rarely fatal, but some people need to be hospitalized.


Avoiding Typhus

Balter urges people to try to prevent the disease by using flea control products on pets. The county plans to distribute flea collars to homeless people in L.A. for use on their pets, she says.

Balter says to remember to use EPA-registered flea repellents, and make sure you don’t leave pet food outdoors that would draw in stray animals. Also, keep garbage cans covered to avoid attracting rodents and other animals.




Sources

Aaron Glatt, MD, spokesman, Infectious Diseases Society of America; chairman of medicine and hospital epidemiologist, South Nassau Communities Hospital, Oceanside, NY.

Sharon Balter, MD, director, division of communicable disease, Los Angeles County Department of Public Health.

CDC: “Murine Typhus.”

City of Pasadena, CA: “Elevated Levels of Flea-Borne Typhus.”

Los Angeles County Department of Public Health news release: “Public Health Reports Several Case of Flea-Borne Typhus.”



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