How LA County plans to tackle the typhus outbreak

Los Angeles County mobile health teams will hand out flea collars, insect repellent and maps to restrooms as part of an emergency plan approved Tuesday to ward off disease-carrying fleas that are spreading typhus at alarming rates in pockets of downtown Los Angeles and throughout Long Beach, Pasadena and the San Gabriel Valley.

The Board of Supervisors, by unanimous vote, also approved a broader pilot program aimed at ridding typhus and hepatitis from a concentrated homeless population in Skid Row and South Los Angeles.  The county’s Department of Public Health detected an outbreak of flea-borne typhus fever in these areas in the last few months that may set a county record for the highest number of cases in one year.

This longer-term effort will include mental health and housing placement workers who will follow law enforcement who break up illegal homeless encampments, and sanitation workers who pick up trash and clean the streets of waste that attract rodents, feral cats and opossums, three major carriers of fleas that transmit typhus.

Typhus is a treatable disease that causes dizziness, high fevers, rashes, nausea and vomiting. It can be fatal in one percent of diagnosed cases.

“I am very concerned, given the patterns of last year with hepatitis cases, and now typhus cases, with the spread of diseases in Los Angeles County,” said Los Angeles County Supervisor Kathryn Barger, who led the effort along with Supervisor Janice Hahn.

Last year the county declared a hepatitis A outbreak and reported 36 cases among its homeless population and men who have sex with men.

This year, a typhus fever outbreak prompted the call for multi-departmental action teams to stamp out communicable diseases and root out homelessness.

Number of cases up

Los Angeles County has identified  64 cases of typhus this year so far, up from 59 on Friday.

A cluster of 11 occurred among the homeless in downtown Los Angeles and four more among those identified as homeless in South Los Angeles, Dr. Barbara Ferrer, director of the county Department of Public Health, told the supervisors at the board meeting.

One case reported by the San Gabriel Valley Tribune involved Tom Sachs, 81, of San Marino, who contracted the disease six months ago and nearly died. He is receiving physical therapy after he couldn’t walk for weeks. He is nearly recovered.

“Flea-borne typhus does not discriminate. Some of the people sickened are people who are housed and some of the people who’ve been sickened are homeless,” Ferrer told the board.

Pasadena has identified 20 cases, more this year than the usual zero to five cases per year, said Rachel Janbek, environmental health division manager with the Pasadena Public Health Department.

Pasadena reported 677 people experiencing homelessness this year, an 18 percent jump from 2017. However, none of those people reported having typhus.

“All of these cases have been among housed people within the city,” Janbek said.

Long Beach has identified 13 people with typhus fever, said Nelson Kerr, manager of environmental health.

“Long Beach is experiencing a higher than normal number of typhus cases this year,” he said. Thirteen is the highest year-to-date number in the port city since 2013, he told the board.

Orange County reported 15 cases so far this year.

“Overall, we haven’t seen the increase in typhus counts reported in Pasadena, Los Angeles and Long Beach,” said Julie MacDonald, spokeswoman for the Orange County Health Care Agency.

Spreading disease

Experts say opossums are a major contributor to the diseases outbreak in Pasadena and parts of LA County near the foothills. But the spread throughout LA County points to a variety of animal hosts.

“Long Beach should be a red flag as it is moving away from the hills toward the ocean,” Barger said.

Ferrer expects the number of typhus cases to level out soon because the disease spreads more rapidly in summer and fall.

“We anticipate we will be at the end of seeing new cases by the end of this month or into early November,” she said.

The two plans will be implemented in a few days or a week. The Board will see a report on progress around the end of November or early December.

At that time, it can decide to make the pilot programs permanent.

The mobile teams will provide:

— Hand sanitizers

— Flea collars for pet owners

— Insect repellent

— Maps of nearest restrooms

— Mobile showers

— Mental health clinicians

— Temporary housing or assessments for permanent housing

— Educational materials on how to avoid the risk of typhus or hepatitis A

Transmission

Fleas transmit typhus by landing on a person’s skin and depositing feces or a bite that transmits one of two kinds of bacteria, Rickettsia typhi or Rickettsia felis, into the bloodstream. Cases will fall off when exposures to the outdoors decrease in cooler months, Ferrer said.

Supervisor Sheila Kuehl worried that some cities and counties would remove encampments, clear out the trash and power wash the streets and river banks, only to see the homeless return weeks later.

That is a cycle the two pilot programs are trying to break, she said.

“It is not enough to go in and get rid of all the trash,” she said. “Hopefully we’d be getting them to a refuge, to a better way of life.”

Staff Writer Deepa Bharath contributed to this article.