The outbreak of flea-borne typhus cases in Los Angeles County is continuing to spread, with health officials announcing Friday they are investigating four new cases in the Willowbrook area.

The Willowbrook cases bring the total number of patients in the county so far this year to 63. Health officials told the county Board of Supervisors earlier this week that there were a total of 67 cases for the entirety of 2017.

Health officials noted that the typhus issue has worsened in recent years, with the average annual number of cases in the county doubling to nearly 60. That figure does not include Pasadena and Long Beach, which operate their own health departments and compile their own statistics.

Pasadena has also reported a spike in typhus cases this year, confirming 20 cases of typhus to date in 2018, compared with a history of one to five cases annually. Long Beach has had double its historical rate of cases, with a total of 12 reported to date, officials said.

At least nine of the Los Angeles County cases occurred in downtown Los Angeles, all among homeless people.

The county Department of Public Health urged people to protect themselves from flea bites that can spread the disease.

“Typhus infection can be prevented through flea control measures on pets, using insect repellent to avoid flea bites and clearing areas that can attract wild or stray animals like cats, rats and opossums,” said Dr. Muntu Davis, the county’s health officer.

Infected fleas are most often spread by rats, cats and opossums, which do not show symptoms of the typhus infection. However, typhus can cause high fever, chills, headache and rash in humans and, if not treated with antibiotics, can also lead to hospitalization and, in rare cases, death.

The disease is not transmitted person-to-person, according to county health officials.

In addition to avoiding contact and keeping fleas off house pets, residents should keep garbage cans tightly covered to discourage wild and stray animals. Health officials also urged people not to leave pet food outdoors, clear years of debris, trim overgrown plants and bushes and block crawl spaces or openings under homes where rats and stray animals can hide.

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