A flea-borne typhus outbreak in the Los Angeles area has also rocked Long Beach – the third city to be struck down in the region.

Officials have this year recorded 12 cases of the bug in the city, home to 470,000 people and around 20 miles (32km) south of downtown LA.

Many of the cases are among homeless people, and it is feared the disease is being spread by rats and feral cats.

A further 20 cases have been recorded in Pasadena since the start of 2018 - and 59 in the whole of LA County in total.

Pasadena and Long Beach are both technically in LA County, however they have their own health departments which record their own figures.

A total of 91 cases of the bacterial disease have now been recorded, with 50 in LA County, 20 in Pasadena, and 12 now in Long Beach, which is the third city to have become affected

Flea-borne typhus occurs when faeces from an infected insect come into contact with a person's cut or gets rubbed into their eyes.

These fleas often live on feral cats and rats who are attracted to areas with trash on the streets.

This year's flea-borne typhus outbreak in LA County is unusually severe. Just 67 cases were recorded in the whole of 2017. And Pasadena and Long Beach have an average of five or six per year.

Officials have not managed to explain why typhus is suddenly spreading in the area as nine cases have been recorded in downtown LA in the past two months. They are investigating the issue.

Symptoms of typhus in humans include fever, chills, headaches, rashes and muscle ache.

In rare cases, the infection can cause liver failure or be fatal – an estimated two to four per cent of untreated patients die.

Los Angeles's county supervisor, Kathryn Barger, has called for more co-operation among health officials, animal control and trash collection across the affected areas, CBS LA reported.

Dr Muntu Davis, the county's health officer, admitted typhus 'normally occurs' throughout the LA region.

However, in a statement issued last week he added: 'We are observing several cases in the downtown Los Angeles area.'

Flea-borne typhus occurs when faeces from an infected insect come into contact with a person's cut or gets rubbed into their eyes. The insects often live on feral cats and rats (stock)

'Public Health is gathering additional information to determine the specific locations in downtown LA where the cases may have been,' officials told L.A. Taco.

Flea-borne typhus occurs when faeces from an infected insect come into contact with a person's cut or gets rubbed into their eyes.

These fleas often live on feral cats and rats which are attracted to areas with trash on the streets.

Twenty residents in Pasadena have been confirmed to have typhus fever this year – up from the expected five cases.

WHAT IS TYPHUS? Typhus is a bacterial disease that causes fever, headache, rash, muscle ache, and fever and chills. In severe cases, patients can require hospitalisation due to hepatitis or internal bleeding. It is caused by the bacteria Rickettsia typhi and possibly Rickettsia felis, which are carried by fleas, lice, mites or ticks. The pests live on animals, particularly feral and stray cats, rats and opossums, but do not make their host animals unwell. Flea-borne typhus is endemic in parts of LA and Orange County. The disease also often occurs in Texas and Hawaii. Around 200 cases occur every year throughout the US, particularly in coastal regions. Bacteria spread when faeces from an infected insect contaminate a person's cut or graze while the insect is sucking their blood. If the person scratches the bite area, the bacteria from the faeces can enter their bloodstream. Bacteria can also be rubbed into a person's eyes, or, in rare cases, inhaled. Symptoms then appear six-to-14 days later. Typhus can be treated via antibiotics, with most people recovering within a few days. Between two and four per cent of people who do not receive treatment die worldwide. Typhus can be prevented by avoiding contact with fleas, mites, ticks and lice via: Discouraging wild animals around the home

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Dr Ying-Ying Goh, Pasadena's health officer, said: 'Typhus fever is a disease that can cause serious complications requiring lengthy hospitalization, and rarely, death.'

She encouraged all residents in the city to take precautions in order to prevent fleas in and around their homes, CNN reported.

Dr Anne Rimoin, an associate professor of epidemiology at the University of California, told CNN: 'Right now, it's hard to speculate on why we are seeing more cases.

'There is an ongoing investigation by the Los Angeles County Department of Public Health that seeks to answer this question.'

It comes after it was last week reported that a dozen cases of the disease appeared in a residential neighbourhood of LA.

All of the sufferers lived or worked in the same area, with some being homeless. The infection usually takes two weeks to cause symptoms.

Dr Davies urged pet owners at the time to practice safe flea control and encourage all cities in the county to clean-up their waste.

He also urged authorities to ensure rodent populations were kept under control.

Typhus usually affects around 200 people across the US every year, according to the California Department of Public Health (CDPH).

Health officials were alerted to the outbreak when a cluster of nine cases occurred in downtown LA between July and August.

The infection is endemic – commonly found – in parts of LA and Orange County, Southern California.

Fleas carrying the infection can live on cats, rats or opossums, however, the animals themselves do not suffer symptoms.

Typhus often spreads in areas where there is an accumulation of trash that attracts wild animals.

The infection cannot be transmitted from person-to-person and is treatable with antibiotics. There is no vaccine in the US.

Up to four per cent of people worldwide who are untreated die, the CDPH claims.

To prevent infection, LA's public health department recommends residents: use flea control on pets, tuck their pants into their socks or boots when outside and avoid wild or stray animals.

Texas experienced a flea-borne typhus outbreak around this time last year.

More than 400 cases occurred from the start of 2017 to the end of November - the highest number for 16 years.