Typhus, a bacterial infection that is sometimes life threatening, is on the rise in Los Angeles and several other U.S. cities. Public health officials say homelessness is making the problem worse and that the disease, which is associated with poverty and poor sanitation, is making a comeback in the United States.
Los Angeles County has seen 64 cases of typhus this year, compared with 53 at the same point last year and double the typical number, with a six-case cluster among the homeless in L.A. this year. Two cities in the county that have separate counts are also seeing higher numbers: Long Beach with 13 cases, up from five last year, and Pasadena with 20, a more than three-fold increase from 2017.
At a clinic in the L.A. neighborhood called Skid Row, Dr. Lisa Abdishoo of Los Angeles Christian Health Centers is on the lookout for symptoms.
“It’s a nonspecific fever,” she said, “body aches, sometimes a headache, sometimes a rash.”
This kind of typhus is spread by fleas on rats, opossums, or even pets and is known as murine typhus, from the Latin word for “mouse.”
The risk is higher when people live on the streets in proximity to garbage, but the disease seems to be spreading through the Southern United States.
Not the typhus of WWI
“It’s never been considered a very common disease,” said Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston, “but we seem to see it more frequently. And it seems to be extending across from Southern California all along the Mexican border into southeastern Texas and then into the Gulf Coast in Florida.”
Texas had 519 cases last year, said spokeswoman Lara Anton of the Texas Department of State Health Services. That’s more than three times the number in 2010, with clusters in Houston and Galveston. No figures for this year have been released.
This is a separate disease from typhoid fever and is not the epidemic form of typhus that caused hundreds of thousands of deaths in war time. That type, called epidemic typhus, is carried by body lice and often spreads in conflict zones. It led to millions of deaths in World War I alone.
Flea-borne typhus, the kind seen in California and Texas, is serious but often clears up on its own and responds to an antibiotic, Abdishoo said.
“It seems to get better a little faster if you have the treatment,” she said. “But there are cases where people have had more severe complications — it’s rare, but getting meningitis, and even death,” she cautioned.
Migration, urbanization, climate change
The reason for increased typhus numbers is uncertain, but it may be linked to migration, urbanization and climate change, said Hotez, the disease specialist. In some parts of the world, typhus is still linked to war and instability, “in the conflict zones in the Middle East, in North Africa, Central Asia, East Africa, Venezuela, for instance with the political instability there,” he said.
Murine typhus is one of several diseases on the rise in the southern United States, Hotez said.
“Others include dengue, now emerging in southern Texas and Florida, the Zika virus infection, Chikungunya. We have a huge problem with West Nile virus,” he added, and Chagas disease, a condition usually seen in Latin America.
A report in May from the U.S. Centers for Disease Control and Prevention found that such “vector-borne” diseases, transmitted by ticks, fleas or mosquitoes, more than doubled in the United States between 2004 and 2016.
Hotez says they are on the rise in many industrial nations with crowded cities and pockets of poverty.
Skid Row physician Abdishoo says flea-borne typhus is still uncommon on the streets of Los Angeles, but “it has us all on high alert for this illness that we don’t necessarily think too much about. We want to be vigilant,” she added, “when you see a communicable disease on the rise.”
Officials in Los Angeles say they are working toward housing for the county’s 53,000 homeless residents to relieve conditions that help give rise to typhus and other diseases. Voters approved funding in 2016 and 2017 to finance the efforts.