ProCite
RefWorks
Reference Manager
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Zotero
EndNote
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Azad AF , Radulovic S , Higgins JA , Noden BH , Troyer JM , 1997. Flea-borne rickettsioses: ecologic considerations. Emerg Infect Dis 3: 319–327.
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Pieracci EG , Evert N , Drexler NA , Mayes B , Vilcins I , Huang P , Campbell J , Behravesh CB , Paddock CD , 2017. Fatal flea-borne typhus in Texas: a retrospective case series, 1985–2015. Am J Trop Med Hyg 96: 1088–1093.
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Tsioutis C , Zafeiri M , Avramopoulos A , Prousali E , Miligkos M , Karageorgos SA , 2017. Clinical and laboratory characteristics, epidemiology, and outcomes of murine typhus: a systematic review. Acta Trop 166: 16–24.
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Blanton LS , 2019. The rickettsioses: a practical update. Infect Dis Clin North Am 33: 213–229.
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Afzal Z , Kallumadanda S , Wang F , Hemmige V , Musher D , 2017. Acute febrile illness and complications due to murine typhus, Texas, USA. Emerg Infect Dis 23: 1268–1273.
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Dumler S , Taylor JP , Walker DH , 1991. Murine typhus in south Texas, 1980 through 1987. JAMA 266: 1365–1370.
-
11.
Adjemian J , Parks S , McElroy K , Campbell J , Eremeeva ME , Nicholson WL , McQuiston J , Taylor J , 2010. Murine typhus in Austin, Texas, USA, 2008. Emerg Infect Dis 16: 412–417.
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Pratt BHD , 1958. The changing picture of murine typhus in the United States. Ann N Y Acad Sci 70: 516–527.
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Anstead GM , 2020. History, rats, fleas, and opossums. II. The decline and resurgence of flea-borne typhus in the United States, 1945–2019. Trop Med Infect Dis 6: 2.
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Blanton LS , Walker DH , 2017. Flea-borne rickettsioses and rickettsiae. Am J Trop Med Hyg 96: 53–56.
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Sawyer W , 1944. Public health implications of tropical and imported diseases. Am J Public Health 34: 7–14.
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Pratt D , Kaplan M , 1998. Evaluation of abnormal liver-enzyme results in asymptomatic patients. N Engl J Med 342: 1369–1373.
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Sherman K , 1992. Alanine aminotransferase in clinical practice. Arch Intern Med 152: 208.
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Siest G , Schiele F , Galteau MM , Panek E , Steinmetz J , Fagnani F , Gueguen R , 1975. Aspartate aminotransferase and alanine aminotransferase activities in plasma: statistical distributions, individual variations, and reference values. Clin Chem 21: 1077–1087.
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Kulldorff M , 1997. A spatial scan statistic. Commun Stat Theory Methods 26: 1481–1496.
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Reporter R , Dassey DE , Mascola L , 1996. Murine typhus still exists in the United States. Clin Infect Dis 23: 205–206.
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California Department of Public Health , 2020. Human Flea-Borne Typhus Cases in California, 2001–2019. Sacramento, CA: CDPH.
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Mellanby K , 1933. The influence of temperature and humidity on the pupation of Xenopsylla cheopis. Bull Entomol Res 24: 197–202.
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Kreppel KS , Telfer S , Rajerison M , Morse A , Baylis M , 2016. Effect of temperature and relative humidity on the development times and survival of Synopsyllus fonquerniei and Xenopsylla cheopis, the flea vectors of plague in Madagascar. Parasit Vectors 9: 1–10.
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29.
Azad AF , Traub R , 1987. Transmission of murine typhus rickettsiae by Leptopsylla segnis (Siphonaptera: Leptopsyllidae). J Med Entomol 24: 689–693.
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30.
Smith A , 1951. The effect of relative humidity on the activity of the tropical rat flea Xenopsylla cheopis (Roths.) (Siphonaptera). Bull Entomol Res 42: 585–599.
-
31.
Hidalgo M , Salguero E , De Ossa A , Sánchez R , Vesga JF , Orejuela L , Valbuena G , 2008. Murine typhus in Caldas, Colombia. Am J Trop Med Hyg 78: 321–322.
-
32.
Hernández-Cabrera M , Angel-Moreno A , Santana E , Bolaños M , Francès A , Martín-Sánchez AM , Pérez-Arellano JL , 2004. Murine typhus with renal involvement in Canary Islands, Spain. Emerg Infect Dis 10: 740–743.
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Surveillance of Flea-Borne Typhus in California, 2011–2019
Kyle Yomogida
Kyle Yomogida
Center for Animal Disease Modeling and Surveillance, School of Veterinary Medicine, University of California, Davis, California;
Vector-Borne Disease Section, California Department of Public Health, Sacramento, California;
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Vector-Borne Disease Section, California Department of Public Health, Sacramento, California;
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Anne Kjemtrup
Anne Kjemtrup
Vector-Borne Disease Section, California Department of Public Health, Sacramento, California;
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Beatriz Martínez-López
Beatriz Martínez-López
Center for Animal Disease Modeling and Surveillance, School of Veterinary Medicine, University of California, Davis, California;
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Mireille Ibrahim
Mireille Ibrahim
Los Angeles County Department of Public Health, Acute Communicable Disease Control Program – Morbidity Unit, Los Angeles, California;
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Zuelma Contreras
Zuelma Contreras
Los Angeles County Department of Public Health, Acute Communicable Disease Control Program – Morbidity Unit, Los Angeles, California;
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Van Ngo
Van Ngo
Los Angeles County Department of Public Health, Acute Communicable Disease Control Program – Morbidity Unit, Los Angeles, California;
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Umme-Aiman Halai
Umme-Aiman Halai
Los Angeles County Department of Public Health, Acute Communicable Disease Control Program – Morbidity Unit, Los Angeles, California;
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Sharon Balter
Sharon Balter
Los Angeles County Department of Public Health, Acute Communicable Disease Control Program – Morbidity Unit, Los Angeles, California;
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Matt Feaster
Matt Feaster
City of Pasadena Public Health Department, Pasadena, California;
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Matthew Zahn
Matthew Zahn
Orange County Health Care Agency, Santa Ana, California;
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Eric Shearer
Eric Shearer
Orange County Health Care Agency, Santa Ana, California;
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Rochelle Sorvillo
Rochelle Sorvillo
Orange County Health Care Agency, Santa Ana, California;
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Nora Balanji
Nora Balanji
Long Beach Department of Health and Human Services, Communicable Disease Control Program, Long Beach, California
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Cindy Torres
Cindy Torres
Long Beach Department of Health and Human Services, Communicable Disease Control Program, Long Beach, California
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Belinda Prado
Belinda Prado
Long Beach Department of Health and Human Services, Communicable Disease Control Program, Long Beach, California
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Charsey Porse
Charsey Porse
Vector-Borne Disease Section, California Department of Public Health, Sacramento, California;
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Vicki Kramer
Vicki Kramer
Vector-Borne Disease Section, California Department of Public Health, Sacramento, California;
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ABSTRACT.
Flea-borne typhus (FBT), also referred to as murine typhus, is an acute febrile disease in humans caused by the bacteria Rickettsia typhi. Currently, cases of FBT are reported for public health surveillance purposes (i.e., to detect incidence and outbreaks) in a few U.S. states. In California, healthcare providers and testing laboratories are mandated to report to their respective local public health jurisdictions whenever R. typhi or antibodies reactive to R. typhi are detected in a patient, who then report cases to state health department. In this study, we characterize the epidemiology of flea-borne typhus cases in California from 2011 to 2019. A total of 881 cases were reported during this period, with most cases reported among residents of Los Angeles and Orange Counties (97%). Demographics, animal exposures, and clinical courses for case patients were summarized. Additionally, spatiotemporal cluster analyses pointed to five areas in southern California with persistent FBT transmission.
- Supplemental Materials (PDF 261.52 KB)
Author Notes
Financial support: K. Y. acknowledges funding support from the
Disclosure: The findings and conclusions in this article are those of the authors and do not necessarily represent the views or opinions of the California Department of Public Health or the California Health and Human Services Agency.
Authors’ addresses: Kyle Yomogida, Center for Animal Disease Modeling and Surveillance, School of Veterinary Medicine, University of California, Davis, CA, and Vector-Borne Disease Section, California Department of Public Health, Sacramento, CA, E-mail: kyle.yomogida@cdph.ca.gov. Anne Kjemtrup, Charsey Porse, and Vicki Kramer, Vector-Borne Disease Section, California Department of Public Health, Sacramento, CA, E-mails: anne.kjemtrup@cdph.ca.gov, charsey.porse@cdph.ca.gov, and vicki.kramer@cdph.ca.gov. Beatriz Martinez-Lopez, Center for Animal Disease Modeling and Surveillance, School of Veterinary Medicine, University of California, Davis, CA, E-mail: beamartinezlopez@ucdavis.edu. Mireille Ibrahim, Zuelma Contreras, Van Ngo, Umme-Aiman Halai, and Sharon Balter, Los Angeles County Department of Public Health, Acute Communicable Disease Control Program – Morbidity Unit, Los Angeles, CA, E-mails: mibrahim2@ph.lacounty.gov, zcontrera@ph.lacounty.gov, vngo@ph.lacounty.gov, uhalai@ph.lacounty.gov, and sbalter@ph.lacounty.gov. Matt Feaster, City of Pasadena Public Health Department, Pasadena, CA, E-mail: mfeaster@cityofpasadena.net. Matthew Zahn, Eric Shearer, and Rochelle Sorvillo, Orange County Health Care Agency, Santa Ana, CA, E-mails: mzahn@ochca.com, eshearer@ochca.com, and rsorvillo@ochca.com. Nora Balanji, Cindy Torres, and Belinda Prado, Long Beach Department of Health and Human Services, Communicable Disease Control Program, Long Beach, CA, E-mails: nora.balanji@longbeach.gov, cindy.torres@longbeach.gov, and. Belinda.prado@longbeach.gov.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Dumler JS , Mandell GL , Bennett JE & Dolin R Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 6th ed. Philadelphia, PA: Elsevier Churchill Livingstone, 2306–2310.
-
2.
Schriefer ME , Sacci JB , Taylor JP , Higgins JA , Azad AF , 1994. Murine typhus: updated roles of multiple urban components and a second typhuslike Rickettsia. J Med Entomol 31: 681–685.
-
3.
Sorvillo FJ , Gondo B , Emmons R , Ryan P , Waterman SH , Tilzer A , Andersen EM , Murray RA , Barr AR , 1993. A suburban focus of endemic typhus in Los Angeles County: association with seropositive domestic cats and opossums. Am J Trop Med Hyg 48: 269–273.
-
4.
Azad AF , Radulovic S , Higgins JA , Noden BH , Troyer JM , 1997. Flea-borne rickettsioses: ecologic considerations. Emerg Infect Dis 3: 319–327.
-
5.
Murray KO , Evert N , Mayes B , Fonken E , Erickson T , Garcia MN , Sidwa T , 2017. Typhus group rickettsiosis, Texas, USA, 2003–2013. Emerg Infect Dis 23: 645–648.
-
6.
Pieracci EG , Evert N , Drexler NA , Mayes B , Vilcins I , Huang P , Campbell J , Behravesh CB , Paddock CD , 2017. Fatal flea-borne typhus in Texas: a retrospective case series, 1985–2015. Am J Trop Med Hyg 96: 1088–1093.
-
7.
Tsioutis C , Zafeiri M , Avramopoulos A , Prousali E , Miligkos M , Karageorgos SA , 2017. Clinical and laboratory characteristics, epidemiology, and outcomes of murine typhus: a systematic review. Acta Trop 166: 16–24.
-
8.
Blanton LS , 2019. The rickettsioses: a practical update. Infect Dis Clin North Am 33: 213–229.
-
9.
Afzal Z , Kallumadanda S , Wang F , Hemmige V , Musher D , 2017. Acute febrile illness and complications due to murine typhus, Texas, USA. Emerg Infect Dis 23: 1268–1273.
-
10.
Dumler S , Taylor JP , Walker DH , 1991. Murine typhus in south Texas, 1980 through 1987. JAMA 266: 1365–1370.
-
11.
Adjemian J , Parks S , McElroy K , Campbell J , Eremeeva ME , Nicholson WL , McQuiston J , Taylor J , 2010. Murine typhus in Austin, Texas, USA, 2008. Emerg Infect Dis 16: 412–417.
-
12.
Pratt BHD , 1958. The changing picture of murine typhus in the United States. Ann N Y Acad Sci 70: 516–527.
-
13.
Anstead GM , 2020. History, rats, fleas, and opossums. II. The decline and resurgence of flea-borne typhus in the United States, 1945–2019. Trop Med Infect Dis 6: 2.
-
14.
Blanton LS , Walker DH , 2017. Flea-borne rickettsioses and rickettsiae. Am J Trop Med Hyg 96: 53–56.
-
15.
Centers for Disease Control and Prevention , 2019. Typhus Fevers. Historical Trends. Available at: https://www.cdc.gov/typhus/murine/history.html. Accessed December 6, 2019.
-
16.
Meleney HE , French R , 1941. Endemic typhus fever in southern California. Cal West Med 62: 116–119.
-
17.
Sawyer W , 1944. Public health implications of tropical and imported diseases. Am J Public Health 34: 7–14.
-
18.
Pratt D , Kaplan M , 1998. Evaluation of abnormal liver-enzyme results in asymptomatic patients. N Engl J Med 342: 1369–1373.
-
19.
Sherman K , 1992. Alanine aminotransferase in clinical practice. Arch Intern Med 152: 208.
-
20.
Siest G , Schiele F , Galteau MM , Panek E , Steinmetz J , Fagnani F , Gueguen R , 1975. Aspartate aminotransferase and alanine aminotransferase activities in plasma: statistical distributions, individual variations, and reference values. Clin Chem 21: 1077–1087.
-
21.
Quest Diagnostics Aspartate Aminotransferase (AST). Available at: https://testdirectory.questdiagnostics.com/test/test-detail/822/aspartate-aminotransferase-ast?cc=MASTER. Accessed November 3, 2020.
-
22.
U.S. Census Bureau QuickFacts: Los Angeles County, California. Available at: https://www.census.gov/quickfacts/losangelescountycalifornia. Accessed February 8, 2021.
-
23.
U.S. Census Bureau QuickFacts: Orange County, California. Available at: https://www.census.gov/quickfacts/fact/table/orangecountycalifornia/PST045221. Accessed February 8, 2021.
-
24.
Kulldorff M , 1997. A spatial scan statistic. Commun Stat Theory Methods 26: 1481–1496.
-
25.
Reporter R , Dassey DE , Mascola L , 1996. Murine typhus still exists in the United States. Clin Infect Dis 23: 205–206.
-
26.
California Department of Public Health , 2020. Human Flea-Borne Typhus Cases in California, 2001–2019. Sacramento, CA: CDPH.
-
27.
Mellanby K , 1933. The influence of temperature and humidity on the pupation of Xenopsylla cheopis. Bull Entomol Res 24: 197–202.
-
28.
Kreppel KS , Telfer S , Rajerison M , Morse A , Baylis M , 2016. Effect of temperature and relative humidity on the development times and survival of Synopsyllus fonquerniei and Xenopsylla cheopis, the flea vectors of plague in Madagascar. Parasit Vectors 9: 1–10.
-
29.
Azad AF , Traub R , 1987. Transmission of murine typhus rickettsiae by Leptopsylla segnis (Siphonaptera: Leptopsyllidae). J Med Entomol 24: 689–693.
-
30.
Smith A , 1951. The effect of relative humidity on the activity of the tropical rat flea Xenopsylla cheopis (Roths.) (Siphonaptera). Bull Entomol Res 42: 585–599.
-
31.
Hidalgo M , Salguero E , De Ossa A , Sánchez R , Vesga JF , Orejuela L , Valbuena G , 2008. Murine typhus in Caldas, Colombia. Am J Trop Med Hyg 78: 321–322.
-
32.
Hernández-Cabrera M , Angel-Moreno A , Santana E , Bolaños M , Francès A , Martín-Sánchez AM , Pérez-Arellano JL , 2004. Murine typhus with renal involvement in Canary Islands, Spain. Emerg Infect Dis 10: 740–743.
-
33.
Tselentis Y , Babalis TL , Chrysanthis D , Gikas A , Chaliotis G , Raoult D , 1992. Clinicoepidemiological study of murine typhus on the Greek island of Evia. Eur J Epidemiol 8: 268–272.
-
34.
Tsioutis C , Chaliotis G , Kokkini S , Doukakis S , Tselentis Y , Psaroulaki A , Gikas A , 2014. Murine typhus in elderly patients: a prospective study of 49 patients. Scand J Infect Dis 46: 779–782.
-
35.
Gikas A , Kokkini S , Tsioutis C , Athenessopoulos D , Balomenaki E , Blasak S , Matheou C , Tselentis Y , Psaroulaki A , 2009. Murine typhus in children: clinical and laboratory features from 41 cases in Crete, Greece. Clin Microbiol Infect 15: 211–212.
-
36.
Whiteford SF , Taylor JP , Dumler JS , 2001. Clinical, laboratory, and epidemiologic features of murine typhus in 97 Texas children. Arch Pediatr Adolesc Med 155: 396–400.
-
37.
Giannini EG , Testa R , Savarino V , 2005. Liver enzyme alteration: a guide for clinicians. C Can Med Assoc J 172: 367–379.
-
38.
Neuschwander-Tetri BA , Ünalp A , Creer MH , 2004. The upper limits of normal for serum ALT levels reported by clinical laboratories depend on local reference populations. Arch Intern Med 168: 663–666.
-
39.
Petroff D , Bätz O , Jedrysiak K , Kramer J , Berg T , Wiegand J , 2022. Age dependence of liver enzymes: an analysis of over 1,300,000 consecutive blood samples. Clin Gastroenterol Hepatol 20: 641–650.
-
40.
Rauch J , Eisermann P , Noack B , Mehlhoop U , Muntau B , Schäfer J , Tappe D , 2018. Typhus group rickettsiosis, Germany, 2010–2017. Emerg Infect Dis 24: 1213–1220.
-
41.
County of Los Angeles Public Health , 2019. Update on Flea-Borne Typhus in Los Angeles County. Available at: http://publichealth.lacounty.gov/phcommon/public/media/mediapubhpdetail.cfm?prid=1987. Accessed February 7, 2019.
-
42.
Nelson K , Maina AN , Brisco A , Foo C , Croker C , Ngo V , Civen R , Richards AL , Fujioka K , Wekesa JW , 2018. A 2015 outbreak of flea-borne rickettsiosis in San Gabriel Valley, Los Angeles County, California. PLoS Negl Trop Dis 12: 1–13.
-
43.
Pasadena Public Health Department , 2018. Elevated Levels of Flea-Borne Typhus. Available at: https://www.cityofpasadena.net/public-health/news-announcements/elevated-levels-of-flea-borne-typhus/. Accessed December 12, 2018.
-
44.
Long Beach Department of Health and Human Services , 2021. Typhus. Available at: https://www.longbeach.gov/health/diseases-and-condition/information-on/typhus/. Accessed November 10, 2021.
-
45.
Office of Health Equity , 2015. Portrait of Promise: The California Statewide Plan to Promote Health and Mental Health Equity. Sacramento, CA: California Department of Public Health.
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