There was an outbreak in California in 2018—could it happen again?

By Sarah Klein
October 31, 2019

In 2018, the state of California had the largest typhus outbreak it had seen in recent history, with 174 total cases—suspected, probable, and confirmed—of the disease, according to the California Department of Public Health (CDPH). 

While 174 cases doesn't seem like a lot in the grand scheme of things, it is a lot for an illness that's still considered a rare disease—the Centers for Disease Control and Prevention (CDC) actually removed typhus from it list of all notifiable diseases in the late 1980s because of its infrequency. And even today, most typhus outbreaks are only seen in California, Hawaii, and Texas. 

Still, typhus is a scary-sounding disease that can actually be pretty tricky to diagnose. Here's what you need to know if you're ever near an outbreak of the flea-borne illness. 

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What exactly is typhus—and how is it different from typhoid?

First things first: One of the biggest misconceptions about typhus is that it’s the same thing as typhoid or typhoid fever—but it's definitely not. “Typhoid is caused by salmonella and you get it basically from eating undercooked chicken or eggs,” Jennifer Hanrahan, MD, chief of the division of infectious diseases at The University of Toledo Medical Center, tells Health. “And typhoid fever is a more aggressive form of that same salmonella infection, common among travelers.”

Flea-borne or murine typhus, on the other hand, is a bacterial infection spread by—you guessed it—fleas. The bacteria usually lives in the fecal matter of fleas that make their homes on wild and stray animals; when your dog or cat comes into contact with an infected flea, it can carry it into your home and spread the disease to you through any openings in your skin (like cuts or scrapes).

But it's not just fleas who can carry typhus, lice can, too—in that case, it's a slightly different form called epidemic typhus, according to the CDC. Yet another type of typhus is known as scrub typhus, and is spread through chiggers or larval mites—but scrub typhus typically only occurs in rural areas of Southeast Asia, Indonesia, China, Japan, India, and northern Australia.

The good news: flea-borne typhus is not spread from person-to-person; people can only become infected when an infected flea bites them and leaves an infected wound, or flea dirt (aka, flea poop), gets into an open cut. Epidemic typhus, however, can be spread from person-to-person. Both types of typhus outbreaks occur mainly in areas with large populations of homeless people, says Dr. Hanrahan. 

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What are typhus symptoms?

Even though typhus enters the body through cuts or scrapes on the skin, it’s not just a dermatological illness. It causes systemic symptoms, including fever, chills, body aches, headaches, muscle pain, and a rash—so basically, it can look a lot like many other diseases. 

“Typhus can be tough to diagnose as the symptoms are not specific and mimic many other conditions,” says Dr. Natasha Bhuyan, M.D., a practicing family physician specializing in infectious diseases. “When the condition worsens, people can have vomiting, abdominal pain, or confusion.”

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How is typhus treated—and how is it prevented?

Once you’ve been diagnosed with typhus, the treatment is actually fairly simple and effective. A round of the antibiotic doxycycline can get rid of the infection and prevent any chronic illness or infection, according to the CDC.

The tricky part, says Hanrahan, is making the diagnosis. Most doctors in the U.S. wouldn’t think to blame typhus for the common infection symptoms it causes, so it’s important to share your recent medical history with your doctor. Mention any pets that live in your home and inform your doctor of any recent travel, insect bites, or time spent in homeless shelters or overcrowded living conditions.

As far as prevention goes, Dr. Bhuyan says the best way to avoid typhus is to steer clear of arthropods (fleas, ticks, mites, and lice) that spread it. There’s no vaccine for any form of typhus, but there are several ways to reduce your exposure and risk. For flea-borne typhus, make sure pets are regularly treated with flea- and tick-repellant, use repellant on yourself when outside, and limit your (and your pet's) contact with wild animals and strays. For epidemic typhus, practice good hygiene and don't share clothing, towels, or bedding items with someone who's infected. 

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