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Texas is seeing an explosion of cases of typhus, a disease that, if untreated, can be fatal. The state now reports the most flea-borne typhus cases in the nation, and that more than 6,700 cases were recorded from 2008–2023, with about 70% of patients hospitalized and 14 deaths attributed over that span.
Typhus is spread by fleas and was almost eradicated from the United States. But now it’s making a comeback, which is something that 76-year-old Dana Clark discovered.
Clark is a longtime San Antonio musician who performs regularly around town but had to stop when in May she contracted typhus.
“I am much better. My energy is not as good as it once was, and I'm a little wobbly, but I'm closing in on getting back to completely normal,” she said.
Clark said she got flea-borne murine typhus from clearing weeds from her garden.
“And I created a lot of dust and just inhaling that dust can give someone typhus. Because of flea excrement,” Clark said.
Typhus spreads from cat and rodent fleas.
There is also a situation related to an animal reservoir—a species or population of animals that harbor pathogens and can transmit them to other animals or humans, often serving as a source of infection.
Reservoir animals include opossums and dogs.
Several days after exposure symptoms often begin with high fever, headache and body aches; a rash can also appear, according to the CDC.
When treated promptly with doxycycline, the outcomes are usually good. But delayed diagnosis increases the risk of complications and hospitalization. That’s what happened to Clark.
“I had just been rehearsing for a concert that was supposed to happen in four days. And right at the end of rehearsal, I suddenly got this wave of exhaustion. By the next day I was really, really sick. I had fever, I had chills, I couldn't eat. I felt weak. And two days after that, I called EMS,” Clark said.
At first doctors couldn’t figure out what was making Clark ill. Meanwhile her condition was getting worse.
Dr. Gregory M. Anstead said what happened to Clark isn’t uncommon. "It's still not an extremely well-known disease in South Texas as a whole. Oftentimes it will present and then it'll be a while before the disease gets properly diagnosed and treated.”
Dr. Gregory M. Anstead is a San Antonio-based infectious disease specialist. A professor at the UT San Antonio Health Science Center, he has conducted extensive research on the resurgence of flea-borne typhus in Texas.
“(In) the 1990s, there were only about 200 cases in the state of Texas. And then if you go ahead, 20 years to the 2010 to 2019, the number of cases went up 12-fold in the state of Texas,” he said.
Texas is seeing a sustained rise in flea-borne typhus, also sometimes called endemic typhus, with cases expanding beyond traditional hotspots in the Rio Grande Valley into major metropolitan areas, including Dallas–Fort Worth, Houston, Austin and San Antonio. Data from the Texas State health Services show 847 cases in 2024, up from 580 in 2022. 2025 is already at 682 provisional cases through Aug. 31, suggesting another high year as the disease typically peaks in late summer and fall.
The comeback of typhus is alarming since in history it used to be a common scourge.
It was so bad in San Antonio in the 1940s that the U.S. military took action and spayed the city with the toxin DDT.
Archive newsreels tell the story: “San Antonio health authorities attacked germ carriers on a city wide front. With war discovered DDT in special sprayers sections of the city are literally fogged with the insecticide.”
The U.S. military used DDT during World War II to delouse service men and others and to fight the spread of malaria in tropical areas. At the time it was thought the DDT was safe for humans and the environment.
“So now the US Public Health Service had this tool, DDT. They took several tons of DDT, and they spread it to 22,000 rooms in urban San Antonio to try to control the typhus problem in San Antonio,” said Anstead.
The military had to take the lead in San Antonio because the city government was so corrupt at the time it couldn’t be trusted to implement the DDT trial program.
Anstead said the application of DDT in San Antonio focused on downtown and impoverished neighborhoods.
“And there's maps of where typhus was back in those days, and it was right downtown that they show exactly where the cases were. And they were very close to Commerce Street and the Riverwalk. I mean, it was in the heart of the city back in those days. And so they spread this DDT over a period of about a year in these premises that were potentially rat infested,” he said.
This city-wide anti-typhus experiment worked. The number of typhus cases dropped. And public health officials used San Antonio as a model in a war against typhus fleas and rats across the South.
“The combination of DDT and also spreading these new rodenticides definitely interrupted this transmission cycle of typhus in the southern United States in the late 1940s,” Anstead said.
But now typhus is back. Climate change is creating better conditions for fleas. Fleas thrive under warmer conditions, reproducing faster and allowing the typhus bacteria to multiply more rapidly—all of which fuels transmission.
State guidance emphasizes pet flea control, yard cleanup (removing brush and outdoor food sources that attract rodents and opossums), and promptly seeking care for unexplained fever — especially after flea bites or exposure to pets and wildlife. Public health officials also remind providers that typhus is reportable in Texas, aiding surveillance and response.
