Health authorities are issuing alerts regarding a typhus outbreak in Los Angeles following the unfortunate deaths of three individuals as a result of the infection. This marks the initial instance of typhus-linked fatalities within the city in a span of thirty years.
In the current month, the United States Centers for Disease Control (CDC) unveiled a comprehensive report, providing insights into the initial three deaths associated with flea-borne typhus in Los Angeles County since 1993. This occurrence signifies the acceleration of a concerning pattern, as the region witnessed a record-breaking 171 cases in 2022, thereby reaching its highest annual peak since 2010.
What exactly is typhus?
Typhus encompasses a group of bacterial diseases that manifest with symptoms such as fever, headaches, and rashes, as outlined by the CDC. These diseases are transmitted to humans through lice, fleas, and chiggers.
The infrequent yet severe symptoms that led to the demise of three individuals in Los Angeles included myocarditis, characterized by inflammation of the heart tissue, and septic shock. The CDC does acknowledge that all three individuals had pre-existing medical conditions, although it remains uncertain whether these underlying health issues contributed to their fatalities.
Dr. William Shaffner, a professor specializing in infectious diseases and preventive medicine at Vanderbilt University, explains that the transmission of the virus begins when an infected flea leaps from its host—be it a rat, dog, cat, or opossum—to a human.
"As it does so, it often defecates. Since the flea bite induces itching, scratching follows. Consequently, you inadvertently scratch into the flea bite, introducing the minuscule amount of feces containing the bacteria."
Therefore, Shaffner clarifies that this is how the disease can be contracted.
Shaffner estimates that in an average year, the United States would anticipate a total of 50 to 100 cases.
Typical symptoms comprise fever, headache, rash, and hepatitis. The primary treatment involves administering a common antibiotic: doxycycline.
Dr. Dung Trinh, an internal medicine specialist based in California and CEO of the Healthy Brain Clinic, advises individuals experiencing such symptoms who have traveled to or reside in affected areas to seek medical attention.
"Diagnostic measures may entail blood tests to detect antibodies to Rickettsia typhi or molecular tests like polymerase chain reaction (PCR) to identify the bacterium's genetic material. In severe instances or when diagnosis remains uncertain, supplementary tests or consultations with specialists might be necessary. Once diagnosed, prompt initiation of doxycycline treatment is generally recommended."
Presently, there is no vaccine available for this particular strain of typhus.
Who faces a higher risk?
Experts emphasize that when promptly treated with antibiotics, typhus transmitted by fleas is exceedingly uncommonly fatal. The CDC's report underlines that the mortality rate is below 1%. Nevertheless, while the occurrence is rare, certain individuals remain at an elevated risk for severe symptoms, potentially leading to fatal outcomes. The CDC's report highlighted that one of the affected individuals was homeless. Schaffner underscores that individuals in unhygienic living conditions, along with their support networks, should be vigilant about adopting preventive measures to evade infection. "Homelessness, given the unfortunate living circumstances of those individuals, inherently increases the risk in areas where the disease is prevalent," Schaffner explained. "For social workers engaging in such environments to assist them, reducing the risk is vital. Using insect repellent plays a crucial role as it helps deter fleas." Trinh adds that safeguarding your pets from flea infestations can also mitigate your infection risk. "Employ flea control products on pets, where applicable, to minimize the chance of fleas entering living spaces. Utilize protective clothing, like long-sleeved shirts and pants, to minimize exposure to fleas and other pests. Apply insect repellents on exposed skin to discourage flea bites and limit direct contact with stray animals, especially those that might harbor fleas, such as rodents or feral cats." Further risk reduction practices encompass laundering bedding, disposing of food waste, maintaining a clean living environment, and adhering to proper hand hygiene protocols.
Additional Incidences of Flea-Borne Typhus Outbreaks
The CDC is currently investigating a surge in cases of flea-borne typhus in Texas. Authorities are also examining the possibility of a disease mutation contributing to this increase, although at present, there is no substantiated evidence to support this theory. Due to past outbreaks, reporting cases of flea-borne typhus is mandatory in California. Moreover, public health specialists will be closely observing animal populations to ascertain whether there is a corresponding rise in the disease among them. "Monitoring infestations of fleas on rodents, opossums, cats, and dogs, as well as tracking the prevalence of infected fleas, holds significant importance in enhancing our understanding of disease ecology and facilitating more targeted interventions to prevent human infections."
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