A healthcare worker treats a male patient in a hospital bed.Share on Pinterest
Typhus can lead fever, headache and rash. to Anna Stills/Getty Images
  • Los Angeles County recently reported its first Typhus-related deaths in more than 30 years.
  • Fleaborne typhus is of concern in areas like southern Texas, California, and Hawaii.
  • Experts say there are multiple steps you can take to reduce this already minimal risk.

Health officials are warning about typhus in Los Angeles after three people died due to the disease. That is the first time deaths related to typhus have been reported in the city in three decades

This month the US Centers for Disease Control (CDC) released a report detailing the first three fleaborne typhus-related deaths in Los Angeles County since 1993. This marks the acceleration of a trend, with the highest number of cases in the region 171 in 2022, reaching their highest peak since 2010.

The number of cases in 2010 was 31.

Typhus refers to a group of diseases that are caused by bacteria, symptoms of typhus can include fevers, headaches, and rash, according to the CDC. The diseases are spread to humans via lice, fleas, and chiggers.

The rare and severe symptoms that led to the three deaths in Los Angeles included myocarditis — where heart tissue becomes inflamed — and septic shock. The CDC does note that all three people had underlying conditions, though it is unclear whether these pre-existing health issues contributed to their deaths.

Dr. William Shaffner , a professor of infectious diseases and preventive medicine at Vanderbilt University, says that the transmission of the disease begins with an infected flea jumping from its host—whether that’s a rat, dog, cat, or opossum, to a human.

“When it does that, it often poops. And what happens is, since the flea bite is itchy, you scratch it. And you actually then scratch into the fleabite. [It’s] that tiny amount of poop which actually contains the bacteria.”

As a result, Shaffner explains you can contract the disease.

Schaffner estimates that in a typical year the US would expect to see 50 to 100 cases total.

Common symptoms include fever, headache, a rash, and hepatitis. The most effective treatment is a common antibiotic: doxycycline.

Dr. Dung Trinh , a California-based internal medicine specialist and CEO at the Healthy Brain Clinic, says that those who experience these symptoms and who have traveled to or live in affected areas should make a point of checking in with a medical professional.

“Diagnostic tests might include blood tests to detect antibodies to Rickettsia typhi or molecular tests like polymerase chain reaction (PCR) to detect the genetic material of the bacterium. In severe cases or when diagnosis is uncertain, additional tests or consultations with specialists may be necessary. Once diagnosed, treatment with doxycycline is usually started promptly.”

There is currently no vaccine for this form of typhus.

Experts stress that when treated with antibiotics, typhus that comes from fleas is very rarely fatal. The CDC shared in their report that the fatality rate is lower than 1%.

But however rare, some people are still at higher risk for severe symptoms including fatal outcomes. The CDC reported one of the people affected was unhoused.

Schaffner says that those in unsanitary living conditions—as well as their support systems—should be mindful of how they can avoid infection.

“Being homeless, given the living circumstances of those unfortunate folks, that puts you at increased risk in endemic areas, of course,” Schaffner said. “And if social workers are going into those circumstances, trying to help them and they want to reduce their risk, insect repellent is very important because that’ll help keep the fleas off.”

Trinh adds that preventing your dog or cat from contracting flees can also reduce your risk of infection.

“Use flea control products on pets, if applicable, to reduce the risk of fleas being brought into living spaces; wear protective clothing, such as long-sleeved shirts and pants, to reduce exposure to fleas and other pests; Use insect repellents on exposed skin to discourage flea bites [and] minimize direct contact with stray animals, especially those that may carry fleas, such as rodents or feral cats.”

Other ways of reducing risk include washing your bedding, getting rid of your food waste, keeping your living space clean, and following proper hand washing procedures.

The CDC is also investigating an increase in flea-borne typhus in Texas. Officials are also looking for signs if the increase in cases is linked to a mutation of the disease. But currently, they say there is no evidence of it.

Due to previous outbreaks, fleaborne typhus is required to be reported in California. Additionally, public health experts will be monitoring animal populations to see if the disease increases there.

“Monitoring rodent, opossum, cat, and dog flea infestations and the numbers of infected fleas is important to better understand disease ecology and more effectively direct interventions to prevent human disease.”

Health officials have issued a warning after three deaths to flea-borne typhus were reported in the Los Angeles area.