County health officials closely watching murine typhus

<strong>A Long Beach map of reported murine typhus cases over the last five years, courtesy of Lamar Rush, Vector Control coordinator for the City of Long Beach Department of Health and Human Services, Bureau of Environmental Health Vector Control Program</strong>
CJ Dablo
Staff Writer

Local health officials are closely tracking murine typhus after two counties noted a rise in the number of people who have been exposed to the disease in recent years. Even though both counties of Los Angeles and Orange have made efforts to alert the public about the increase in the number of murine typhus cases, it’s not an easily recognizable disease. Symptoms include fever that can last a few days, headaches and sometimes a rash.
According to figures provided by its public health department, LA County saw 31 cases last year in which individuals had contracted murine typhus, a disease spread through infected fleas. That number was one of the biggest on record, according to Dr. Rachel Civen, an LA County public health official. In Southern California, the strain of bacteria that is infecting these fleas is called rickettsia typhi.
With two months left in this year, LA County has so far confirmed 16 cases for 2011. Orange County reported 11 cases for the same time period, according to the Orange County Health Care Agency.
Suburban neighborhoods like the ones in Signal Hill and Long Beach are special targets because of the kinds of animals that may be responsible for spreading the disease to people. In Southern California, health officials have named primarily possums and cats– both feral and domestic outdoor cats– as potential carriers of the fleas that cause murine typhus.
Civen, a medical epidemiologist with the Acute Communicable Disease Control Program of the LA County Department of Public Health, emphasized in a telephone interview that opossums are one of the biggest risk factors for murine typhus.
“One of the biggest thing[s] is having possums that you spot in your back yard, in the neighborhood, because the possum is the biggest flea bag in the world,” Civen said Tuesday, explaining that fleas can jump from possums to cats and eventually to humans.
Other animals can be exposed to the fleas too, but Long Beach is concentrating its efforts on possums and feral cats, according to Lamar Rush, who works for the City’s vector control department.
Health officials are continuing to talk about typhus because it is a preventable disease, according to Dr. Michele Cheung in an interview on Tuesday. Cheung is the interim medical director of epidemiology for the OC Health Care Agency. She stressed taking action to decrease wildlife around the home and proactive flea control.
LA County’s department of public health also weighed in on other ways people can prevent exposure to typhus. Civen recommended measures to discourage possums and other wildlife from staying near people. In a 2008 article she co-authored with Dr. Van Ngo published in Clinical Infectious Diseases, Civen recommended trimming back foliage in the yard to avoid providing a harbor for animals. Installing screens on windows and crawl spaces would also bar animals from entering the house, according to the article. She also recommended eliminating potential food sources like pet food and open trash cans around the house.
Both LA and Orange county officials noted that medical professionals also need to be aware of typhus when treating patients. It’s a problem when doctors mistake typhus for the flu, meningitis or a number of other possible infectious diseases.
Cheung confirmed that her agency is pushing for more public awareness so that clinicians can recognize the disease more easily.
“I’m sure there’s many [typhus cases] that are not recognized, so it is under-diagnosed. So there may be milder cases. Usually ones we hear about have been ill for a while, and that’s why the physician decided to test for it,” Cheung said, adding that studies have found that the fatality rate is less than one percent.
Civen also stressed that there would be a problem if a doctor doesn’t consider testing a patient for typhus.
“That’s what’s tough about diagnosing this disease [because] it looks so much like many things including…West Nile Virus infection…Basically to get the diagnosis, you have to have a physician that is aware of this infection and will order the appropriate tests,” Civen said.
Both Cheung and Civen emphasize that once diagnosed, the disease is easily treated. Specific antibiotics can be prescribed. Civen said that patients can see a turnaround in 48 hours.
Signal Tribune staff has been affected by murine typhus. Barbie Ellisen, who works in the newspaper’s advertising department, thought she had the flu when she went to see her doctor in September. For several days, Ellison’s body ached and her temperature spiked upwards to 104 and 105 degrees.
After her hospital ran several tests, Ellisen was initially diagnosed with the flu and sent home. She was later rushed to the emergency room then hospitalized when symptoms became worse. They tested for West Nile Virus, swine flu, and typhus. She said that it wasn’t until about the ninth day when a test came back and health professionals determined she had actually developed typhus.
She remembered that her condition had gotten so bad that her hands had to be restrained because hospital staff were concerned she would pull the breathing tube out of her throat.
“I couldn’t breathe. I couldn’t talk…My hands were tied down to my side. And I was on a breathing apparatus. So it was scary. I honestly thought I was dying,” Ellisen said in a telephone interview Tuesday.
Ellisen was lucky. She has a sister who is a nurse and a brother-in-law who is a doctor. Both, Ellisen said, were actively fighting for her health care, especially when it wasn’t clear what her diagnosis was. Her relatives even asked for a change in doctors and asked for a pulmonary specialist and another specialist in infectious diseases, she said.
Ellisen acknowledged that it hasn’t been easy, but she is still grateful to be here and that she has a brother-in-law who checked in with her doctors two to three times a day and then took the time to explain the complicated case to Ellisen’s worried husband. Her voice broke a few times as she recalled how much her family had done for her. She’s recovering at home. She doesn’t know how she developed the disease. She had already sprayed her yard for fleas and treated her dogs for fleas too. She didn’t even know she had been bitten.
“But I’m alive,” Ellisen said. “I’m alive now. So that’s a good thing

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