Recent typhoid cases present no cause for alarm

SUZANNE BELLING

One recent death and three other reported cases “prompted an investigation”, Blumberg says.

Three of the cases probably were infected outside South Africa and “imported” to this country. The only cases that are linked are those of two siblings.

“Based on that, there is not an outbreak, because they have different sources,” she says.

In the case of an outbreak, there is a link to common exposure. The locally reported cases are “sporadic” and do not represent an outbreak for this reason.

The NICD is the national public health institute for South Africa, providing reference, surveillance and public health research to support the government’s response to threats from communicable diseases.  

The NICD primarily supports the programmes of the national and provincial departments of health, as well as public health services such as collaborating laboratory or regional reference laboratory functions for global programmes of the World Health Organisation. 

Blumberg is also deputy director of the National Health Laboratory Service and head of the Public Health Surveillance and Response Division.

With specialist qualifications in clinical microbiology, travel medicine and infectious diseases, she is a member of the joint staff at the University of the Witwatersrand and associate professor at the University of Stellenbosch in the department of medical microbiology.

Typhoid, also know as typhoid fever or enteric fever, is highly infectious, but is not that easy to catch, with around 100 000 infectious organisms required to cause infection.

The disease spreads through the ingestion of contaminated food and water containing faecal matter. It is common in communities where there is inadequate sanitation.

Symptoms include high fever, headache, abdominal discomfort, often with vomiting and diarrhoea and skin rash (“rose spots”). The incubation period is usually between 10 to 14 days.

Typhoid is endemic in this country and the southern African region. Approximately 100 cases are reported in this country every year throughout all nine provinces.

Contamination of water supplies has resulted in several large-scale outbreaks. Delmas in Mpumalanga, for example, has experienced repeated outbreaks, with over 1 000 cases in 1991 and over 400 in 2005, with three deaths. 

A number of South Africa cases have been linked to an ongoing typhoid outbreak in Harare, Zimbabwe, that began in 2012 and was related to contaminated water sources. Over 4 000 cases have been diagnosed to date.

The numbers usually increase in summer because of seasonal changes or people being infected with typhoid while travelling to neighbouring countries in December.

Every case is investigated by health officials to confirm the likely source and protect the health of the public.

Health workers are on the lookout for cases of typhoid and also to ensure that other conditions that present with similar signs, such as malaria, are appropriately diagnosed and treated.

The drug of choice in treating typhoid fever is Ciprofloxacin, which resolves the symptoms and avoids the patient remaining a carrier of the disease after treatment. Other treatments are also available, but not always with results that are as favourable.

The three most effective methods of preventing typhoid are strict hand washing with soap and water after using the toilet and before handling food, providing safe water and adequate sanitation.

Animals are not affected by typhoid.