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Published Date: 2009-10-25 20:00:03
Subject: PRO/AH/EDR> Murine typhus - USA (03): (CA)
Archive Number: 20091025.3692

MURINE TYPHUS - USA (03): (CALIFORNIA)
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Date: 14 Sep 2011
Source: The Orange County Register [edited]
http://healthyliving.ocregister.com/2011/09/14/flea-borne-again-a-problem-in-o-c/38358/

A total of 5 people in Orange County [O.C.], including one under 18, have been diagnosed with confirmed or probable infections caused by flea-borne typhus during the past 3 months, the county's Health Care Agency [HCA] reported Wednesday [14 Sep 2011].

Symptoms include fever, headache, muscle aches and a rash on the chest, back, arms or legs. The disease is treatable with antibiotics, but it can be fatal if left untreated, says Michael Hearst, district manager for the county's Vector Control. The disease, also known as endemic typhus, isn't passed from person to person. Instead, it's transmitted by the bites of infected fleas. In most of the O.C. cases the past few years, people have been infected by a family cat, although other animals can carry the fleas, including rats, opossums and raccoons. "Everybody we talked to had adopted a feral cat, or had a cat that was in and out a lot," Hearst said.

"Between 1994 and 2005, there were no reported cases of flea-borne typhus in the county. There was one case in 2006, 6 in 2007, 15 in 2008, and 6 cases each in 2009 and 2010. We've had more cases in the last 3 years than in the previous 50," Hearst said. There have been 8 reported cases in 2011. Of the 5 in the last 3 months, 4 were adults and one was under 18, HCA said. All live in North County, although infected animals can be found in any part of the county.

What can people do to protect themselves from flea-borne typhus? Here are some tips offered by HCA:
- Treat pets regularly with flea-prevention medications.
- Avoid contact with rodents, opossums, feral cats or other animals that may have fleas.
- Close openings to attics and crawl spaces in your home, and keep vents and screens in good repair to prevent animals from getting in.
- Report dead animals to your local Animal Control agency. OC Animal Care covers 17 O.C. cities, as well as unincorporated areas. For other cities, consult the OCAC website, http://www.OCPetInfo.com.
- Remove or trim overgrown vegetation or ground cover where wild animals may hide or nest.
- Keep trashcans covered, and remove outdoor sources of food and water, like pet food and fallen fruit from trees.

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[The following is extracted from ProMED-mail post Murine typhus - USA: (TX) 20110607.1734:

"Murine typhus, which occurs throughout the world, is a flea-borne rickettsial disease caused by the _Rickettsia typhi_. Rats are the primary animal reservoir of _R. typhi_; however, other mammals, such as free-ranging cats, dogs, and opossums and their fleas can maintain this microorganism in areas where rats and rat fleas are absent (Azad AF, Radulovic S, Higgins JA, et al: Flea-borne rickettsioses: ecologic considerations. Emerg Infect Dis 1997; 3(3): 319-27; available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2627639/).

"Humans are usually infected by contact with infected flea feces, either by inoculation into excoriated fleabites, inhalation, or ingestion. Symptoms include fever, headache, chills, vomiting, nausea, myalgias, and rash. The illness usually resolves within 3 weeks, even if untreated. However some patients are sick enough to be hospitalized in an intensive care unit and up to 4 percent of hospitalized patients will die from the infection. Treatment is doxycycline. Prevention is directed at control of flea vectors and animal reservoirs.

"Murine typhus occurs in the USA in southern Texas, southern California, and Hawaii. In 2008, 33 laboratory-confirmed cases of murine typhus occurred in Austin, Texas (see ProMED-mail post Murine typhus - USA (04): (TX) 2008-2009 20091120.3995). Illness ranged from mild to severe, with 73 percent of patients requiring hospitalization. Environmental investigation at the time suggested that opossums and domestic animals likely played a role in the maintenance and spread of _R. typhi_."

Orange County is a county in the U.S. state of California. As of the 2010 census, its population was 3 010 232, making it the 3rd most populous county in California, behind Los Angeles County and San Diego County and the 6th most populous county in the United States as of 2009 (http://en.wikipedia.org/wiki/Orange_County,_California). The county is known for its tourism. It is the home of such attractions as Disneyland. The county can be located on a map at http://en.wikipedia.org/wiki/File:Map_of_California_highlighting_Orange_County.svg and the state of California can be located on the HealthMap/ProMED-mail interactive map at http://healthmap.org/r/008X. - Mod.ML]

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